Asprin and statin use for management of atherosclerotic cardiovascular disease in liver transplant candidates: Are we missing the mark?

Liver transplantation is a high-risk, high-cost intervention that extends life in more than 7000 patients in the United States each year. cardiovascular disease negatively affects LT outcomes

Lisa B. VanWagner

2018

Scholarcy highlights

  • Liver transplantation is a high-risk, high-cost intervention that extends life in more than 7000 patients in the United States each year. cardiovascular disease negatively affects LT outcomes
  • In the current issue of Liver Transplantation, Patel et al report findings from a single-center, retrospective cohort study on adherence to guideline-based use of aspirin and statins and 6-month adverse event outcomes among 84 LT candidates with coronary artery disease
  • The sample size in hepatology is exceedingly small compared with the general population, and rapid physiologic changes that occur in decompensated cirrhosis may result in a significant competing risk for non-CVD events, such as sepsis and bleeding. elucidating the impact of statin and aspirin use on hard atherosclerotic cardiovascular disease outcomes may be difficult to assess in patients with decompensated cirrhosis
  • The transplant rate in the current study was 40%, and as the authors note, no conclusions can be made about the risk/benefit profile of these medications on posttransplant outcomes given the small sample size
  • The current aspirin dose recommendation for patients with established ASCVD is 81 mg daily. The relationship between aspirin dose/dual antiplatelet therapy and the reported decrease in platelet count by the authors would be very helpful for interpreting potential bleeding risk
  • VanWagner, M.D., M.Sc. 1,2 1Department of Medicine Division of Gastroenterology and Hepatology, and 2Department of Preventive Medicine Feinberg School of Medicine Northwestern University, Chicago, IL

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