Deep Vein Thrombosis and Pulmonary Embolism in Cirrhosis Patients

Gulley, D. D.; Teal, Evgenia; Suvannasankha, Attaya; Chalasani, Naga; Liangpunsakul, Suthat

doi:10.1007/s10620-008-0265-3

Cited by 179 publications

(199 citation statements)

References 12 publications

Supporting

Mentioning

180

Contrasting

Unclassified

Order By: Relevance

“…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

View full text Add to dashboard Cite

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.

show abstract

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

View full text Add to dashboard Cite

show abstract

“…24 Three recent independent studies have been published specifically evaluating the prevalence of deep vein thrombosis (DVT) and pulmonary embolism (PE) in patients with cirrhosis. [25][26][27] The incidence of DVT/PE ranged from 0.5% to 1.87% in these studies. Interestingly one fifth of cirrhotic patients were receiving antithrombotic prophylaxis with drugs or compression devices at the time they experienced the thrombotic event.…”

Section: Pathophysiologymentioning

confidence: 99%

“…Decreased hepatic synthetic function as reflected by albumin levels was associated with increased risk of DVT/PE, suggesting a greater tendency to thrombosis in advanced stages of cirrhosis. 25,26 The incidence of PVT has also been reported to be higher in patients with more severe cirrhosis. 12 Some interesting in-vitro evidence also supports these clinical findings.…”

Section: Pathophysiologymentioning

confidence: 99%

Portal Vein Thrombosis in Cirrhosis

Raja

Jacob

Asthana

2014

Journal of Clinical and Experimental Hepatology

View full text Add to dashboard Cite

Portal vein thrombosis (PVT) is being increasingly recognized in patients with advanced cirrhosis and in those undergoing liver transplantation. Reduced flow in the portal vein is probably responsible for clotting in the spleno-porto-mesenteric venous system. There is also increasing evidence that hypercoagulability occurs in advanced liver disease and contributes to the risk of PVT. Ultrasound based studies have reported a prevalence of PVT in 10-25% of cirrhotic patients without hepatocellular carcinoma. Partial thrombosis of the portal vein is more common and may not have pathophysiological consequences. However, there is high risk of progression of partial PVT to complete PVT that may cause exacerbation of portal hypertension and progression of liver insufficiency. It is thus, essential to accurately diagnose and stage PVT in patients waiting for transplantation and consider anticoagulation therapy. Therapy with low molecular weight heparin and vitamin K antagonists has been shown to achieve complete and partial recanalization in 33-45% and 15-35% of cases respectively. There are however, no guidelines to help determine the dose and therapeutic efficacy of anticoagulation in patients with cirrhosis. Anticoagulation therapy related bleeding is the most feared complication but it appears that the risk of variceal bleeding is more likely to be dependent on portal pressure rather than solely related to coagulation status. TIPS has also been reported to restore patency of the portal vein. Patients with complete PVT currently do not form an absolute contraindication for liver transplantation. Thrombectomy or thromboendovenectomy is possible in more than 75% of patients followed by anatomical end-to-end portal anastomosis. When patency of the portal vein and/or superior mesenteric vein is not achieved, only non-anatomical techniques (reno-portal anastomosis or cavo-portal hemitransposition) can be performed. These techniques, which do not fully reverse portal hypertension, are associated with higher morbidity and mortality risks in the short term. ( J CLIN EXP HEPATOL 2013;4:320-331)

show abstract

“…Furthermore, this partial deficiency of anticoagulant proteins in those with advanced chronic liver disease is accompanied by enhanced thrombin generation within these patients (Gatt et al, 2010), together resulting in a procoagulant state. This could in part explain why the historical assumption that cirrhotics are 'auto-anticoagulated' and therefore protected against developing peripheral thromboembolic disease has now been demonstrated to be untrue.Studies have demonstrated an incidence of between 0.5-6.3% of newly-diagnosed pulmonary thromboembolism (PE) or deep vein thrombosis (DVT) amongst hospitalised cirrhotics, and cirrhotic patients do not demonstrate a reduced risk of PE/ DVT compared to non-cirrhotic patients (Northup et al, 2006, Gulley et al, 2008. Furthermore, a prolonged international normalised ratio (INR) does not negate a risk of venous thromboembolism (VTE) in this setting (Dabbagh et al, 2010).…”

mentioning

confidence: 99%

“…Studies have demonstrated an incidence of between 0.5-6.3% of newly-diagnosed pulmonary thromboembolism (PE) or deep vein thrombosis (DVT) amongst hospitalised cirrhotics, and cirrhotic patients do not demonstrate a reduced risk of PE/ DVT compared to non-cirrhotic patients (Northup et al, 2006, Gulley et al, 2008. Furthermore, a prolonged international normalised ratio (INR) does not negate a risk of venous thromboembolism (VTE) in this setting (Dabbagh et al, 2010).…”

mentioning

confidence: 99%