Prevention of Liver Fibrosis and Hepatocellular Carcinoma Using Antiplatelet Drugs: A Systematic Review and Meta-analysis.

Goal: The aim of our research was to compile and analyze all existing observational data through a meta-analysis, evaluating the relationship between antiplatelet drugs, such as aspirin and clopidogrel, and the risks of liver fibrosis, portal vein thrombosis (PVT), and hepatocellular carcinoma (HCC).

Background: The association between antiplatelet drug use, especially the use of agents other than aspirin, and liver fibrosis, PVT, and HCC in patients with liver disease remains unclear.

Study: Cochrane Library, Web of Science, EMBASE, and PubMed were searched for all records from their inception through Jul. 20, 2024. Per the defined inclusion and exclusion criteria, we carried out literature screening and data extraction. Following that, the quality of these studies was appraised with the Newcastle-Ottawa Scale. The primary outcomes were liver fibrosis, HCC, and PVT. Statistical analysis was conducted using Stata 17.

Results: The final analysis included 29 studies with 13,000 patients. Pooled results showed the HCC incidence after antiplatelet drug treatment was 3.6% (95% CI: 2.4%, 5.2%). The incidence of PVT after antiplatelet drug treatment was 48.6% (95% CI: 29.8%, 67.8%). Compared with the group not using antiplatelet drugs, the risk of liver fibrosis [hazard ratio (HR): 0.65, 95% CI: 0.56, 0.77; P<0.001] and the risk of HCC (HR: 0.63, 95% CI: 0.54, 0.73; P<0.001) were notably reduced in the group using antiplatelet drugs.

Conclusions: The use of antiplatelet drugs may help prevent liver fibrosis, PVT, and HCC. Owing to the constraints of existing evidence, high-quality randomized controlled studies are essential to further corroborate these findings.