The risk of gastrointestinal bleeding with dual antiplatelet therapy in cirrhotics undergoing liver transplant evaluation.

Background: Metabolic dysfunction-associated steatohepatitis (MASH) cirrhosis is now the second leading indication for liver transplantation (LT) worldwide and is associated with increased risk of cardiovascular events before and after LT. Cirrhotics who undergo left heart catheterization (LHC) with coronary artery stenting for LT evaluation require dual antiplatelet therapy (DAPT). Data regarding the safety, risk of gastrointestinal (GI) bleeding, and mortality risk of cirrhotics receiving DAPT is limited.

Aim: The objective of this study was to assess the risk of and outcomes related to GI bleeding in cirrhotics undergoing LT evaluation who received DAPT.

Methods: We conducted a retrospective review of adults with decompensated cirrhosis who underwent a LHC as part of LT evaluation between 2014 and 2021.

Results: A total of 291 patients were included. Thirty-three underwent LHC with coronary artery stenting and received DAPT, while 258 underwent LHC without intervention and received no DAPT. When comparing the DAPT and control groups, there were no significant differences in the following: GI bleeding on univariate analysis (9.09% vs 14.73%; p= 0.381) and multivariate analysis (odds ratio = 0.579; 95% confidence interval = 0.168 - 1.992; p = 0.386); recurrent GI bleeding (0% vs 4.26%; p = 0.227); variceal hemorrhage (3.03% vs 4.65%; p = 0.671); liver transplanation (30.30% vs 44.19%; p = 0.129); or 12-month mortality following GI bleeding (3.03% vs 5.81%; p = 0.509).

Conclusions: Use of DAPT was not associated with an increased risk of GI bleeding or bleeding-related complications in decompensated cirrhotics with coronary artery disease undergoing LT evaluation.