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Antiplatelet therapy associated with lower prevalence of advanced liver fibrosis in non-alcoholic fatty liver disease: A systematic review and meta-analysis

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Abstract

Despite the growing disease burden of non-alcoholic fatty liver disease (NAFLD), approved medical treatments to improve or prevent liver fibrosis are effective only in a small number of patients. Recent studies have found the new use of antiplatelet agents for antifibrotic benefits in NAFLD, but human studies are still limited. The goal of this meta-analysis was to combine the findings of existing relevant studies to investigate the effects of antiplatelet therapy in reducing or preventing advanced liver fibrosis in patients with NAFLD. We conducted a systematic literature search in PubMed, EMBASE, and Web of Science databases from inception to January 2021 to identify all original studies that investigated the use of antiplatelet agents in patients with NAFLD. We used the National Institutes of Health’s quality assessment tool for observational cohort and cross-sectional studies to assess study quality and risk of bias. The primary outcome was the prevalence of advanced liver fibrosis stage 3–4. Data from each study was combined using the random-effects, generic inverse variance method of DerSimonian and Laird to calculate pooled odds ratio (OR) and 95% confidence intervals (CIs). Of the 2,498 studies identified, 4 studies involving 2,593 patients with NAFLD were included in this study (949 antiplatelet agent users and 1,644 non-antiplatelet agent users). The use of aspirin and/or P2Y12 receptor inhibitors was associated with a lower pooled OR of advanced liver fibrosis in patients with NAFLD (pooled OR = 0.66; 95% CI: 0.53–0.81, I2 = 0.0%; p < 0.001). This study focuses on the outcome of advanced liver fibrosis in patients with NAFLD. Our study is limited by the small number of studies that were included. Preliminary evidence from this meta-analysis suggests a protective association between antiplatelet therapy and the prevalence of advanced liver fibrosis in patients with NAFLD. Our findings support future research into repositioning an antiplatelet agent as a novel NAFLD treatment.

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Data availability

Template data collection forms, data extracted from included studies, data used for all analyses, analytic code, and any other materials used in the review will be provided upon request to corresponding author.

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Acknowledgements

We would like to thank Dr. Poemlarp Mekraksakit for his intellectual assistance with the eligibility criteria.

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Authors and Affiliations

  1. Department of Internal Medicine, Texas Tech University Health Sciences Center, 3601 4th Street, Stop 9410, Lubbock, TX, 79430, USA

    Thanita Thongtan, Anasua Deb, Sameer Islam & Ebtesam Islam

  2. Division of Cardiovascular Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA, 55242, USA

    Wasawat Vutthikraivit

  3. Division of Digestive Diseases and Nutrition, University of Kentucky, Lexington, KY, 40536, USA

    Passisd Laoveeravat & Thammasak Mingbunjerdsuk

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  1. Thanita Thongtan
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Contributions

T.T. conception, design, data interpretation, manuscript drafting, and corresponding. A.D. manuscript drafting, data acquisition, and quality assessment. W.V. conception, data acquisition, and statistical analysis. P.L. and T. M. data interpretation. E.I. and S.I. manuscript revision.

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Correspondence to Thanita Thongtan.

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TT, AD, LV, PL, TM, SI, and EI declare no competing interests.

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The authors are solely responsible for the data and the contents of the paper. In no way, the Honorary Editor-in-Chief, Editorial Board Members, the Indian Society of Gastroenterology or the printer/publishers are responsible for the results/findings and content of this article.

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Thongtan, T., Deb, A., Vutthikraivit, W. et al. Antiplatelet therapy associated with lower prevalence of advanced liver fibrosis in non-alcoholic fatty liver disease: A systematic review and meta-analysis. Indian J Gastroenterol 41, 119–126 (2022). https://doi.org/10.1007/s12664-021-01230-3

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