Effectiveness and safety of antiplatelet therapy in stroke recurrence prevention in patients with liver cirrhosis: a 2-year follow-up study

Background: Data are limited on antiplatelet therapy for ischemic stroke prevention in liver cirrhosis patients.

Methods: This retrospective study identified cases of liver cirrhosis from the National Health Insurance Research Database. Antiplatelet therapy was administered for 2 years to patients who had experienced a first ischemic stroke between 1997 and 2006. Primary outcomes, including death and readmission to hospital for stroke, and secondary outcomes, including death, stroke, or gastrointestinal bleeding, were examined.

Results: One thousand one hundred eighty patients experienced a first stroke. According to time-dependent analysis, the hazard ratio for primary outcomes in patients treated with aspirin was 0.915 (95%CI: 0.872-0.960). In secondary outcomes, hazard ratio for readmission for stroke was 0.904 (95%CI: 0.836-0.978) and that for gastrointestinal bleeding was 0.998 (95%CI: 0.946-1.052) in patients treated with aspirin. Subgroup analysis showed that aspirin was more effective in patients with non-alcoholic cirrhosis than in those with other types of liver cirrhosis. Moreover, hyperlipidemia and statins may have decreased the efficacy of antiplatelet therapy in cirrhosis patients.

Conclusions: This study includes the largest sample for evaluating outcomes of antiplatelet therapy in liver cirrhosis patients for preventing recurrent stroke. The study results show that antiplatelet therapy still offers safe and effective treatment for ischemic stroke prevention in patients with cirrhosis.