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

Abstract

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.

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

“…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].…”

Viral hepatitis and anti-phospholipid antibodies positivity: A systematic review and meta-analysis

“…Since most of the coagulation factors and natural anticoagulants are synthesized in the liver, there has always been a general assumption that patients with liver disease or cirrhosis are "autoanticoagulated" because of low coagulation factors levels [48]. However, experimental [49] and clinical evidence [47,50] recently challenged this issue.…”

Splanchnic and Extrasplanchnic Thrombosis in Cirrhosis: Prophylaxis vs Treatment

“…Diabetes [29] and NAFLD [36] were found as the only independent risk factor for DVT in some studies. A limitation in the analysis of risk factors is that they were not all investigated among different studies.…”

“…Treatment Options for VTE Data on treatment for established VTE in patients with cirrhosis are similarly limited [26,29], particularly regarding the incidence, severity, and origin of the bleeding episodes [26].…”