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| |  Are Analgesics Dangerous to Cirrhotic Patients at Risk for Decompensation?: Presented at ACG By Danny Kucharsky PHILADELPHIA, PA -- October 16, 2007 -- Therapeutic doses of analgesics do not appear to put cirrhotics at increased risk for decompensation, suggest researchers presenting results of a study here at the American College of Gastroenterology (ACG) 2007 Annual Scientific Meeting. The study results were "surprising," said lead investigator Roger Coron, MD, Resident, Division of Internal Medicine, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, United States. "For a long time we've been avoiding [analgesics] in patients with liver failure," he noted, adding that over-the-counter analgesics are hypothesised to increase the risk of hepatic decompensation, leading to increased hospitalisation rates in patients with cirrhosis. The study included 90 non-encephalopathic cirrhotic subjects who were hospitalised at the Thomas Jefferson University Hospital with acute decompensation events, which included portal hypertensive bleeding and, peritonitis, and 125 non-hospitalised cirrhotic controls. Thirty-day analgesic use and potential confounding factors for hepatic decompensation were ascertained, including alternative medication use and alcohol use. All controls had a history of decompensation, indicating that cases and controls were roughly at similar risk for decompensation due to cirrhosis alone. Overall, 34% of patients and 44% of controls reported analgesic use over the 30 days prior to being interviewed, but the difference was not statistically significant. Analgesic use was not significantly associated with decompensation (adjusted OR =.69, P =.234), a pattern that was consistent for all classes of analgesics. There was a trend toward decompensation (adjusted OR = 2.02) among those who took analgesics 4 weeks prior to being interviewed, but the effect was not statistically significant (P =.112). Dr. Coron said the lack of an expected deleterious effect of analgesics could be explained by infrequent use and low doses. The trend toward higher risk for decompensation among those who used analgesics 4 weeks prior, however, indicates that an effect may exist. "I wouldn't start giving [Tylenol to] patients with liver failure…who aren't already taking it," Dr. Coron noted. "The goal is to [conduct] a larger study. It's possible if we had 500 patients, we would have seen a significant difference."
[Presentation title: The Risk of Analgesics in Cirrhotics. Abstract P81]
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