Pulmonary embolism and deep venous thrombosis in hospitalized patients with liver cirrhosis

Kohsaka, Shun; Nagai, Toshiyuki; Yaegashi, Makito; Fukuda, Keiichi

doi:10.1111/j.1872-034x.2011.00941.x

Cited by 6 publications

(4 citation statements)

References 3 publications

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“…Most of such studies have been limited by small sample size, short follow-up period, and lack of detailed information about the VTE event and its management. 7,9 In a recent investigation based on administrative codes, Søgaard et al reported markedly lower rates of anticoagulation use but remarkably higher rates of all-cause 30-day mortality compared with our study (including a 35% mortality rate in PE patients with cirrhosis and 16% in those without cirrhosis). 16 These mortality rates are surprisingly high and may reflect errors related to ascertainment or coding in that study.…”

Section: Discussioncontrasting

confidence: 51%

“…4 Therefore, some patients with cirrhosis, particularly those with additional risk factors for thrombosis (such as surgery and malignancy), may also be at increased risk of venous thromboembolism (VTE) including deep vein thrombosis (DVT) and pulmonary embolism (PE). 1,[5][6][7][8] Data on the frequency, clinical course, and management of limb DVT or PE in patients with liver cirrhosis are limited, 9 and the natural history of these patients has not been clearly elucidated. There are no detailed guidelines for the treatment or monitoring of response to anticoagulant therapy in patients with cirrhosis, in part, because it is a common exclusion criterion in randomized trials of antithrombotic therapy for VTE.…”

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confidence: 99%

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Venous Thromboembolism in Patients with Liver Cirrhosis: Findings from the RIETE (Registro Informatizado de la Enfermedad TromboEmbolica) Registry

Bikdeli

Jiménez

García–Tsao

et al. 2019

Semin Thromb Hemost

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Patients with cirrhosis are not only at an increased risk of bleeding but also at risk of venous thromboembolism (VTE). We sought to determine the clinical characteristics, management, and outcomes after VTE in patients with cirrhosis. We used the data from RIETE (Registro Informatizado de la Enfermedad TromboEmbolica), an international registry of patients with VTE, to compare the outcomes in patients with and without cirrhosis. Main outcomes included all-cause mortality, pulmonary embolism (PE)-related mortality, recurrent VTE, and bleeding. Among 43,611 patients with acute VTE, 187 (0.4%) had cirrhosis. Of these, 184 (98.4%) received anticoagulation for a median of 109 days (interquartile range [IQR]: 43–201 days), most commonly with enoxaparin (median dose: 1.77 [IQR: 1.38–2.00] mg/kg/day). Compared with patients without cirrhosis, those with cirrhosis had a higher rate of all-cause mortality (10.7 vs. 3.4%; odds ratio [OR]: 3.41; 95% confidence interval [CI]: 2.03–5.46) and fatal bleeding (2.1 vs. 0.2%; OR: 13.94; 95% CI: 3.65–37.90) but similar rates of fatal PE (0.5 vs. 0.5%; OR: 1.17; 95% CI: 0.03–6.70). Patients with cirrhosis had a higher rate of all-cause mortality per 100 patient-years of follow-up (58.9 vs. 16.0; hazard ratio [HR]: 3.70; 95% CI: 2.69–4.91). One-year hazard ratio of clinically relevant bleeding (HR: 2.86; 95% CI: 1.91–4.27), fatal bleeding (HR: 8.51; 95% CI: 3.5–20.7), or recurrent VTE (HR: 2.08; 95% CI: 1.00–4.36) was higher in patients with cirrhosis. Cirrhosis is a challenging comorbidity in patients with VTE. Most patients were treated with anticoagulation and had an elevated risk of recurrence, similar risk of fatal PE, and a very high risk of bleeding including fatal bleeds.

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Section: Discussioncontrasting

confidence: 51%

mentioning

confidence: 99%

Venous Thromboembolism in Patients with Liver Cirrhosis: Findings from the RIETE (Registro Informatizado de la Enfermedad TromboEmbolica) Registry

Bikdeli

Jiménez

García–Tsao

et al. 2019

Semin Thromb Hemost

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“…After screening of titles and abstracts, 84 studies were selected for further search, 29 studies [3,12,14,17,[21][22][23][24][25][26][27][28][29][44][45][46][47][48][49][50][51][52][53][54][55][56][57][58][59] reporting incidence or prevalence of VTE in CLD were included (Fig. 1).…”

Section: Resultsmentioning

confidence: 99%

Incidence and prevalence of venous thromboembolism in chronic liver disease: A systematic review and meta-analysis

Subhani

Sheth

Ahmed

et al. 2022

Thrombosis Research

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“…Shun Kohsaka el al. ( 19 ) analyzed 719 medical records of CLD (chronic liver disease) and found 10 patients with VTE at an incidence of 1.4%. They also showed higher platelet counts and INR values in VTE cases.…”

Section: Resultsmentioning

confidence: 99%

Venous thromboembolism in in-hospital cirrhotic patients: A systematic review

et al. 2022

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IntroductionPatients with liver cirrhosis are at a higher risk of hospitalization. The present review aimed to assess the risk of thromboembolism and its burden on hospitalized cirrhotic patients.Materials and methodsA systematic review (PROSPERO: CRD42021256869) was conducted in PubMed, Embase, Cochrane, Lilacs, and a manual search of references. It evaluated studies that compare cirrhotic patients with venous thromboembolism (VTE) with cirrhotic patients without VTE or studies that compare cirrhotic patients with non-cirrhotic patients. No restrictions were set for the date of publication or language. The last search was conducted in June 2021.ResultsAfter selection, 17 studies were included from an initial search of 5,323 articles. The chronic liver disease etiologies comprise viral, alcohol, autoimmune, NASH (non-alcoholic steatohepatitis), cryptogenic, hemochromatosis, cholestasis, and drug-related. The included studies were conflicted regarding the outcomes of VTE, pulmonary embolism, or bleeding. Patients with cirrhosis associated with VTE had prolonged length of hospital stay, and patients with cirrhosis were at higher risk of portal thrombosis.ConclusionIn-hospital cirrhotic patients are a heterogeneous group of patients that may present both thrombosis and bleeding risk. Clinicians should take extra caution to apply both prophylactic and therapeutic anticoagulation strategies.Systematic review registration[https://www.crd.york.ac.uk/PROSPERO/], identifier [CRD42021256869].

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Pulmonary embolism and deep venous thrombosis in hospitalized patients with liver cirrhosis

Cited by 6 publications

References 3 publications

Venous Thromboembolism in Patients with Liver Cirrhosis: Findings from the RIETE (Registro Informatizado de la Enfermedad TromboEmbolica) Registry

Venous Thromboembolism in Patients with Liver Cirrhosis: Findings from the RIETE (Registro Informatizado de la Enfermedad TromboEmbolica) Registry

Incidence and prevalence of venous thromboembolism in chronic liver disease: A systematic review and meta-analysis

Venous thromboembolism in in-hospital cirrhotic patients: A systematic review

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