Coagulopathy Does Not Fully Protect Hospitalized Cirrhosis Patients from Peripheral Venous Thromboembolism

Northup, Patrick G.; McMahon, M.; Rühl, Anne; Altschuler, Scott E; Volk-Bednarz, Agata; Caldwell, Stephen H.; Berg, Carl L.

doi:10.1111/j.1572-0241.2006.00588.x

Cited by 346 publications

(342 citation statements)

References 21 publications

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“…Venous thromboembolism is considered a very rare event in patients with liver cirrhosis, with unpredictable course and unclear mechanism. When comparing our results with the report by Northup et al [6], we found that the incidence of DVT was higher in our series. This discrepancy might be due to different characteristics of our study populations.…”

Section: Discussionsupporting

confidence: 77%

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Deep vein thrombosis in patients with advanced liver cirrhosis: a rare condition?

Lesmana

Inggriani²,

Cahyadinata³

et al. 2010

Hepatol Int

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Purpose Patients with liver cirrhosis are generally considered to be ''auto-anticoagulated'' because of coagulopathy and thrombocytopenia. However, deep vein thrombosis (DVT) has been reported in patients with liver cirrhosis. The objectives of this study were to know the prevalence of DVT among cirrhotic patients and to compare clinical pictures between cirrhotic patients with and without DVT. Methods A case-control study was performed on the basis of medical record data of patients with liver cirrhosis admitted between August 2004 and July 2007 in Medistra hospital in Jakarta. Diagnosis of DVT was established by duplex Doppler ultrasonography of the lower extremities. Patients with splanchnic thrombosis were excluded from this study. Diagnosis of liver cirrhosis was based on history and clinical manifestation, consistent with liver cirrhosis and confirmed by ultrasonography or computed tomography. Results A total of 256 patients with liver cirrhosis were included in this study; 164 (64.1%) among them were men. Patients' mean age was 60.5 ± 12.5 years, ranging from 16 to 88 years. Viral hepatitis accounted for 74.6% of patients with liver cirrhosis. DVT was found in 12 (4.7%)patients. There was no significant laboratory difference between cirrhotic patients with and without DVT (serum albumin, platelet count, aminotransferases, c-glutamyl transpeptidase, alkaline phosphatase, total bilirubin levels, and prothrombin time). Diabetes mellitus was significantly higher in the DVT group than that in the control group (66.6 vs. 34.0%, P = 0.025). Multivariate analysis confirmed diabetes mellitus as an independent risk factor for the occurrence of DVT (odds ratio = 4.26; 95% confidence interval = 1.206-15.034; P = 0.024). Conclusions The prevalence of DVT in patients with liver cirrhosis was 4.7%, and Deep vein thrombosis is not a rare condition in cirrhotic patients with coagulopathy and warrants further studies on the mechanisms and prevention.

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Section: Discussionsupporting

confidence: 77%

“…The first study on hypercoagulation in cirrhotic patients reported that approximately 0.5% of all admissions resulted in a new diagnosis of a VTE event, which consisted of 65.5% DVT, 19.5% pulmonary embolism (PE), and 15% both [6]. The mechanisms of thrombosis are not clear and no other report has studied this phenomenon in more detail.…”

Section: Introductionmentioning

confidence: 99%

Deep vein thrombosis in patients with advanced liver cirrhosis: a rare condition?

Lesmana

Inggriani²,

Cahyadinata³

et al. 2010

Hepatol Int

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“…In patients with cirrhosis VTE may occur either in portal or peripheral veins [42,43]. When VTE occurs, the use of anti-coagulants (heparins and VKA) becomes an option.…”

Section: Monitoring Anti-thrombotic Therapymentioning

confidence: 99%

“…Estimates of VTE in patients with cirrhosis are discordant [42,43,[166][167][168][169][170][171][172][173][174][175][176], due to retrospective collection of data, high heterogeneity of patients' characteristics, and study design. Reported rates range from 0.5% to 6.7% for incidence (Table 2), and from 0.6% to 4.7% for prevalence (Table 3), with higher values in patients with more severe liver disease [173] and in those with hepatocellular carcinoma [176].…”

Section: Venous Thromboembolism In Liver Cirrhosismentioning

confidence: 99%

Hemostatic balance in patients with liver cirrhosis: Report of a consensus conference

Andriulli

Tripodi

Angeli

et al. 2016

Digestive and Liver Disease

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a b s t r a c tPatients with cirrhosis present with hemostatic alterations secondary to reduced availability of procoagulant and anti-coagulant factors. The net effect of these changes is a rebalanced hemostatic system. The Italian Association of the Study of the Liver (AISF) and the Italian Society of Internal Medicine (SIMI) promoted a consensus conference on the hemostatic balance in patients with cirrhosis. The consensus process started with the review of the literature by a scientific board of experts and ended with a formal consensus meeting in Rome in December 2014. The statements were graded according to quality of evidence and strength of recommendations, and approved by an independent jury. The statements presented here highlight strengths and weaknesses of current laboratory tests to assess bleeding and thrombotic risk in cirrhotic patients, the pathophysiology of hemostatic perturbations in this condition, and outline the optimal management of bleeding and thrombosis in patients with liver cirrhosis.

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“…Lowering or normalizing INR values in patients with bleeding events, such as variceal bleeding, does not lead to improved outcomes or decreased failure rates in hemorrhage control [15]. Additionally, a study by Ewe found that INR was not predictive of liver bleeding time after laparoscopic liver biopsy [16]. …”

Section: Discussionmentioning

confidence: 99%

Coagulation in chronic liver disease and the use of prothrombin complex concentrate for an emergent procedure: a case report and review of literature

Laubham

Kallwitz

2018

Journal of Community Hospital Internal Medicine Perspectives

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Synthetic dysfunction observed in cirrhosis results in altered production of procoagulants and anticoagulants that can lead to both bleeding and thrombotic events, respectively. In patients with decompensated cirrhosis, frequent hospital visits often require bedside procedures such as diagnostic paracenteses, thoracenteses and endoscopy. It can be difficult to determine at what coagulation threshold procedures can safely be performed. Currently, the most common therapies given pre-procedurally include fresh frozen plasma (FFP) and vitamin K. The effectiveness of these treatments is estimated by international normalized ratio (INR), an imprecise measure of coagulation in the setting of cirrhosis. Transfusion with FFP may lead to detrimental side effects, including worsening volume overload and increased portal hypertension. We present a case of a 60-year-old patient intubated for acute hypoxic respiratory failure secondary to volume overload who subsequently developed bilateral pneumothoraces, requiring immediate chest tube placement. In this case, the patient had ongoing hepatic decompensation with volume overload and acute worsening of coagulopathy with an INR of 4.2. In this setting, 4-Factor Prothrombin Complex Concentrate (4F-PCC) was chosen to correct coagulation parameters with a low infusion volume. One hour following administration, INR was 1.5. Chest tubes were placed bilaterally and oxygenation improved without bleeding complications. While the data is still lacking, 4F-PCC may be considered for urgent and emergency situations in cirrhotic patients.

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Coagulopathy Does Not Fully Protect Hospitalized Cirrhosis Patients from Peripheral Venous Thromboembolism

Cited by 346 publications

References 21 publications

Deep vein thrombosis in patients with advanced liver cirrhosis: a rare condition?

Deep vein thrombosis in patients with advanced liver cirrhosis: a rare condition?

Hemostatic balance in patients with liver cirrhosis: Report of a consensus conference

Coagulation in chronic liver disease and the use of prothrombin complex concentrate for an emergent procedure: a case report and review of literature

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