Benefit and Harm of Aspirin on Mortality From Gastrointestinal Cancers Vs Bleeding in Helicobacter pylori-Eradicated Patients

Ka Shing Cheung; Bofei Li; Ian Yu-Hong Wong; Simon Law; Wai K Leung

doi:10.1016/j.cgh.2024.05.003

Benefit and Harm of Aspirin on Mortality From Gastrointestinal Cancers Vs Bleeding in Helicobacter pylori-Eradicated Patients

Clin Gastroenterol Hepatol. 2024 May 13:S1542-3565(24)00442-7. doi: 10.1016/j.cgh.2024.05.003. Online ahead of print.

Authors

Ka Shing Cheung¹, Bofei Li², Ian Yu-Hong Wong³, Simon Law³, Wai K Leung⁴

Affiliations

¹ Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong; Department of Medicine, The University of Hong Kong-Shenzhen Hospital, China.
² Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Hong Kong; Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China.
³ Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Hong Kong.
⁴ Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong. Electronic address: waikleung@hku.hk.

PMID: 38750871
DOI: 10.1016/j.cgh.2024.05.003

Abstract

Background & aims: We investigated the benefit-risk profile of aspirin on mortality reduction from chemoprevention of gastrointestinal (GI) cancer vs excess mortality from bleeding among Helicobacter pylori-eradicated patients, and its interaction with proton pump inhibitors (PPIs).

Methods: H pylori-eradicated patients (between 2003 and 2016), identified from a territory-wide database, were observed from the date of H pylori therapy until death or the end of the study (July 2020). Primary exposure was aspirin use as time-varying variable. The primary outcome was GI cancer-related (gastrointestinal, hepatobiliary, or pancreatic cancer) death and the secondary outcome was bleeding-related (gastrointestinal bleeding or intracranial bleeding) death. The adjusted hazard ratio (aHR) of outcomes was calculated by multivariable Cox model after adjusting for age, sex, comorbidities, and concomitant medications. The benefit-risk profile was expressed as the adjusted absolute risk difference of cancer-related deaths and bleeding-related deaths between aspirin users and nonusers.

Results: A total of 87,967 subjects were followed up for a median of 10.1 years, with 1294 (1.5%) GI cancer-related deaths and 304 (0.3%) bleeding-related deaths. Aspirin was associated with lower GI cancer-related mortality (aHR, 0.51; 95% CI, 0.42-0.61), but higher bleeding-related mortality (aHR, 1.52; 95% CI, 1.11-2.08). Among PPI users, the aHR of bleeding-related mortality with aspirin was 1.06 (95% CI, 0.70-1.63). For the whole cohort, the adjusted absolute risk difference between aspirin users and nonusers was 7 (95% CI, 5-8) fewer cancer-related and 1 (95% CI, 0.3-3) more bleeding-related death per 10,000 person-years. Among concomitant PPI-aspirin use, there were 9 (95% CI, 8-10) fewer cancer-related deaths per 10,000 person-years without an increase in bleeding-related deaths.

Conclusions: GI cancer mortality benefit from aspirin outweighs bleeding-related mortality in H pylori-eradicated subjects, which is enhanced further by PPI use.

Keywords: Aspirin; Chemoprevention; Gastrointestinal Cancer; H pylori.