Avi Leader1, Ravit Zelikson-Saporta2, David Pereg3, Galia Spectre1, Uri Rozovski1, Pia Raanani1, Doron Hermoni4, Michael Lishner5. 1. Institute of Hematology, Davidoff Cancer Center, Beilinson Hospital, Rabin Medical Center, Petah Tikva, Israel; Sackler School of Medicine, Tel Aviv University, Israel. 2. Sackler School of Medicine, Tel Aviv University, Israel; Department of Medicine A, Meir Medical Center, Kfar Saba, Israel. 3. Sackler School of Medicine, Tel Aviv University, Israel; Department of Cardiology, Meir Medical Center, Kfar Saba, Israel. 4. Sackler School of Medicine, Tel Aviv University, Israel; Department of Family Medicine, Sharon-Shomron District, Clalit Health Services, Netanya, Israel. 5. Sackler School of Medicine, Tel Aviv University, Israel; Department of Medicine A, Meir Medical Center, Kfar Saba, Israel. Electronic address: michael2@clalit.org.il.
Abstract
BACKGROUND: Multiple studies have shown an association between aspirin treatment and a reduction in newly diagnosed cancer. Conversely, there are conflicting clinical and laboratory data on the effect of combined clopidogrel and aspirin therapy on cancer incidence, including analyses suggesting an increased cancer risk. No large-scale cohort study has been performed to address this issue in a heterogeneous real-world scenario. We investigated the effect of clopidogrel and aspirin on cancer incidence compared with aspirin alone and no antiplatelet therapy. METHODS: A population-based historical cohort study of subjects aged ≥50 years covered by Clalit Health Services, an Israeli health maintenance organization, was performed. Patients treated with the newer antiplatelet drugs, prasugrel or ticagrelor, which, like clopidogrel, inhibit adenosine diphosphate receptors, and those with prior cancer were excluded. Prescription records of antiplatelet medication were retrieved. RESULTS: The cohort included 183,912 subjects diagnosed with 21,974 cancer cases based upon the International Classification of Diseases, Ninth Revision. Dual aspirin and clopidogrel was prescribed in 9.6%, while 49% received aspirin alone and 41% used neither. Compared with nonusers, there was a lower risk of cancer in subjects exposed to aspirin with (hazard ratio [HR] 0.46; 95% confidence interval [CI], 0.44-0.49) or without clopidogrel (HR 0.54; 95% CI, 0.52-0.56), on long-term follow-up. Combined treatment was associated with a lower cancer risk than the aspirin-only group (HR 0.92; 95% CI, 0.86-0.97). CONCLUSIONS: Dual clopidogrel and aspirin treatment is safe regarding the cancer risk. This study generates the hypothesis that clopidogrel may reduce cancer incidence.
BACKGROUND: Multiple studies have shown an association between aspirin treatment and a reduction in newly diagnosed cancer. Conversely, there are conflicting clinical and laboratory data on the effect of combined clopidogrel and aspirin therapy on cancer incidence, including analyses suggesting an increased cancer risk. No large-scale cohort study has been performed to address this issue in a heterogeneous real-world scenario. We investigated the effect of clopidogrel and aspirin on cancer incidence compared with aspirin alone and no antiplatelet therapy. METHODS: A population-based historical cohort study of subjects aged ≥50 years covered by Clalit Health Services, an Israeli health maintenance organization, was performed. Patients treated with the newer antiplatelet drugs, prasugrel or ticagrelor, which, like clopidogrel, inhibit adenosine diphosphate receptors, and those with prior cancer were excluded. Prescription records of antiplatelet medication were retrieved. RESULTS: The cohort included 183,912 subjects diagnosed with 21,974 cancer cases based upon the International Classification of Diseases, Ninth Revision. Dual aspirin and clopidogrel was prescribed in 9.6%, while 49% received aspirin alone and 41% used neither. Compared with nonusers, there was a lower risk of cancer in subjects exposed to aspirin with (hazard ratio [HR] 0.46; 95% confidence interval [CI], 0.44-0.49) or without clopidogrel (HR 0.54; 95% CI, 0.52-0.56), on long-term follow-up. Combined treatment was associated with a lower cancer risk than the aspirin-only group (HR 0.92; 95% CI, 0.86-0.97). CONCLUSIONS: Dual clopidogrel and aspirin treatment is safe regarding the cancer risk. This study generates the hypothesis that clopidogrel may reduce cancer incidence.
Authors: Monika Haemmerle; Rebecca L Stone; David G Menter; Vahid Afshar-Kharghan; Anil K Sood Journal: Cancer Cell Date: 2018-04-12 Impact factor: 31.743
Authors: Lucas T Woods; Kevin Muñoz Forti; Vinit C Shanbhag; Jean M Camden; Gary A Weisman Journal: Biochem Pharmacol Date: 2021-01-04 Impact factor: 5.858
Authors: Marek Z Wojtukiewicz; Dominika Hempel; Ewa Sierko; Stephanie C Tucker; Kenneth V Honn Journal: Cancer Metastasis Rev Date: 2017-06 Impact factor: 9.264
Authors: Loreen Kloss; Claudia Dollt; Kai Schledzewski; Andreas Krewer; Susanne Melchers; Calin Manta; Carsten Sticht; Carolina de la Torre; Jochen Utikal; Viktor Umansky; Astrid Schmieder Journal: Cell Death Dis Date: 2019-10-07 Impact factor: 8.469