VTE burden ‘significant’ in patients with cirrhosis
MedWire News: A substantial proportion of patients with cirrhosis are hospitalized with venous thromboembolism (VTE) throughout the year, US study data show.
The risk for VTE is increased among older patients and those with advanced comorbidity, remark Muhammad Ali (Medical College of Wisconsin, Milwaukee) and colleagues. These patients should therefore receive appropriate measures, including compression stockings or heparin products, to prevent VTE.
"Among the myriad pathological changes and complications of cirrhosis, coagulopathy and potential risk for subsequent bleeding present a frequent problem," write the researchers in the journal Digestive Diseases and Sciences.
"Studies have indicated that in addition to a decrease in the procoagulant factors synthesized by the liver, there is a corresponding and sometimes greater decrease in anticoagulant factors as well," they add.
As a result, previous studies have shown conflicting data regarding VTE risk among patients with cirrhosis.
Ali and team therefore used data from the Nationwide Inpatient Sample 2005 to determine the prevalence of, and risk factors for, VTE (deep vein thrombosis [DVT] and pulmonary embolism [PE]) in patients with cirrhosis.
During 2005 there were 449,798 hospitalizations for cirrhosis, of which 8231 (1.8%) were associated with VTE.
The researchers note that this rate was lower than that for patients with chronic hepatitis C (2.4%) or for all hospitalized patients (3.7%).
Compared with cirrhotic controls who did not have VTE, patients with VTE had a lower rate of cirrhosis-related complications such as hepatic encephalopathy (18.7 vs 22.8%), variceal bleeding (6.0 vs 8.6%), ascites (26.5 vs 30.9%), and coagulopathy (5.9 vs 9.3%).
On multivariate regression, greater co-morbidity (Charlson Index ≥3; odds ratio [OR]=1.71), Black race (OR=1.25), malnutrition (OR=1.29), and central venous line placement (OR=1.70) were all independently associated with a greater risk for VTE.
Of note, neither DVT nor PE was associated with greater in-hospital mortality, but DVT was associated with a 52% increase in the length of hospitalization compared with controls.
"Despite the coagulopathy often associated with cirrhosis, VTE still occurs at a significant rate and merits targeted interventions to reduce its occurrence in these patients," Ali and co-authors remark.
"Further prospective studies are required to establish incidence, risk factors, and to establish guidelines for VTE prophylaxis for patients with cirrhosis," they conclude.
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By Laura Dean