Xiong Wei, Deng Zhenzhong, Cheng Yi, Song Xiaoyang, Yao Qihuan, Qu Jianmin, Xu Mei, Han Fengfeng, Guo Xuejun, Luo Yong
Department of Pulmonary and Critical Care Medicine, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
BMC Med. 2025 Jul 28;23(1):444. doi: 10.1186/s12916-025-04284-8.
Although aspirin was reported to have primary thromboprophylactic efficacy on cancer patients, its adjuvant role in the treatment of patients with cancer-associated venous thromboembolism (VTE) has been unclear yet.
Patients with cancer-associated VTE were retrospectively analyzed and divided into aspirin group and non-aspirin group based on whether they underwent low-dose aspirin (100 mg daily) in addition to conventional anticoagulants. Propensity score matching was used to balance baseline characteristics between the aspirin group and non-aspirin group in a 1:2 ratio. The primary, secondary, and tertiary outcomes were VTE recurrence, mortality and major bleeding, and net clinical benefit (NCB), at 6 months after VTE diagnosis, respectively.
The VTE recurrence occurred in 13 (3.1%) in the aspirin group (N = 423) and 55 (6.5%) in the non-aspirin group (N = 846) (hazard ratio [HR] 0.546, 95% confidence interval [CI] [0.298-0.988], P = 0.011). The PE-related mortality occurred in 12 (2.8%) in the aspirin group and 46 (5.4%) in the non-aspirin group (HR 0.535, 95% CI [0.283-0.909], P = 0.037). The all-cause mortality occurred in 108 (25.5%) in the aspirin group and 228 (27.0%) in the non-aspirin group (HR 0.983, 95% CI [0.782-1.237], P = 0.887). The major bleeding occurred in 52 (12.3%) in the aspirin group and 46 (5.4%) in the non-aspirin group (HR 2.448, 95% CI [1.646-3.641], P < 0.001). The NCB occurred in 274 (64.8%) in the aspirin group and 554 (65.5%) in the non-aspirin group (HR 0.976, 95% CI [0.801-1.189], P = 0.812).
For patients with cancer-associated VTE, the adjuvant use of low-dose aspirin based on conventional anticoagulants improves VTE recurrence and PE-related mortality, compared with isolated use of anticoagulants, whereas it does not improve all-cause mortality or net clinical benefit. Adjuvant low-dose aspirin use is associated with an increased risk of bleeding.
尽管有报道称阿司匹林对癌症患者有一级血栓预防疗效，但其在癌症相关静脉血栓栓塞症（VTE）患者治疗中的辅助作用尚不清楚。
对癌症相关VTE患者进行回顾性分析，并根据是否在常规抗凝剂基础上使用低剂量阿司匹林（每日100毫克）分为阿司匹林组和非阿司匹林组。采用倾向评分匹配以1:2的比例平衡阿司匹林组和非阿司匹林组之间的基线特征。主要、次要和三级结局分别为VTE诊断后6个月时的VTE复发、死亡率和大出血以及净临床获益（NCB）。
阿司匹林组（N = 423）中有13例（3.1%）发生VTE复发，非阿司匹林组（N = 846）中有55例（6.5%）发生VTE复发（风险比[HR] 0.546，95%置信区间[CI] [0.298 - 0.988]，P = 0.011）。阿司匹林组中有12例（2.8%）发生PE相关死亡，非阿司匹林组中有46例（5.4%）发生PE相关死亡（HR 0.535，95% CI [0.283 - 0.909]，P = 0.037）。阿司匹林组中有108例（25.5%）发生全因死亡，非阿司匹林组中有228例（27.0%）发生全因死亡（HR 0.983，95% CI [0.782 - 1.237]，P = 0.887）。阿司匹林组中有52例（12.3%）发生大出血，非阿司匹林组中有46例（5.4%）发生大出血（HR 2.448，95% CI [1.646 - 3.641]，P < 0.001）。阿司匹林组中有274例（64.8%）出现NCB，非阿司匹林组中有554例（65.5%）出现NCB（HR 0.976，95% CI [0.801 - 1.189]，P = 0.812）。
对于癌症相关VTE患者，与单纯使用抗凝剂相比，在常规抗凝剂基础上辅助使用低剂量阿司匹林可改善VTE复发和PE相关死亡率，但不能改善全因死亡率或净临床获益。辅助使用低剂量阿司匹林与出血风险增加相关。
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