From the Guidelines
Patients with liver cirrhosis should avoid taking aspirin 325 mg daily due to the increased risk of bleeding and potential worsening of liver function. Aspirin's blood-thinning properties can further increase the bleeding risk, particularly concerning for potential gastrointestinal bleeding or varices that commonly occur with cirrhosis 1. According to the evidence, NSAIDs, including aspirin, should be avoided in persons with cirrhosis because of the potential for hematologic and renal complications 1.
Key Considerations
- Aspirin can stress the already compromised liver, potentially worsening liver function
- Cirrhosis often causes low platelet counts and impaired clotting factor production, increasing the risk of bleeding
- Aspirin's blood-thinning properties can further increase this bleeding risk
- Alternative medications or lower doses may be considered by a doctor for patients with a medical condition requiring antiplatelet therapy
Recommendations
- Consult with a hepatologist or gastroenterologist before taking any medication, including over-the-counter drugs like aspirin
- Evaluate individual risk factors and liver function to make appropriate recommendations
- Consider alternative medications or lower doses based on the specific situation
- Avoid NSAIDs, including aspirin, in persons with cirrhosis due to the potential for hematologic and renal complications 1
From the Research
Aspirin Use in Liver Cirrhosis Patients
- The use of aspirin in patients with liver cirrhosis has been studied in various research papers 2, 3, 4, 5, 6.
- A study published in 2023 found that daily aspirin use was associated with a reduced risk of hepatocellular carcinoma (HCC) and overall mortality in patients with cirrhosis 4.
- Another study from 2012 showed that aspirin therapy was effective in preventing recurrent stroke in patients with liver cirrhosis, with a hazard ratio of 0.915 for primary outcomes 3.
- However, a 2024 study found that daily use of antiplatelets other than aspirin was associated with a lower incidence of HCC, but also increased the risk of intracranial hemorrhage and overall mortality 2.
Safety Considerations
- Patients with liver cirrhosis may have altered pharmacokinetics and pharmacodynamics, which can affect the safety of medication use, including aspirin 6.
- A 2023 study found that patients with metabolic dysfunction-associated steatotic liver disease (MASLD) had preserved in vitro responses to antiplatelet drugs, including aspirin 5.
- However, the same study found that patients with type 2 diabetes and steatosis had a higher rate of aspirin resistance, which may affect the efficacy of aspirin therapy 5.
Dosage and Administration
- The studies did not specifically address the safety of aspirin 325 milligrams daily in patients with liver cirrhosis.
- However, the studies suggest that aspirin can be used safely in patients with liver cirrhosis, but the dosage and administration should be carefully considered based on individual patient characteristics and medical history 3, 4, 6.