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

Subhani, Mohsan; Sheth, Abhishek; Ahmed, Jamal; Wijayasiri, Pramudi; Gardezi, Syed Anjum Ali; Enki, Doyo Gragn; Morling, Joanne R; Aithal, Guruprasad P.; Ryder, Stephen D.; Aravinthan, Aloysious

doi:10.1016/j.thromres.2022.05.004

Cited by 7 publications

(6 citation statements)

References 68 publications

(177 reference statements)

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“…A recent meta-analysis including 19 million patients reported that just over 25% of patients with cirrhosis hospitalized for medical conditions received vCP. 8 This current study focused only on trauma patients and found that nearly 65% of patients with cirrhosis hospitalized for longer than two days received vCP. The significantly higher rate of vCP in trauma patients compared to medical patients can be explained by the fact that trauma patients are inherently at higher risk for VTE, and vCP is almost always part of an ICU and trauma checklist during rounds.…”

Section: Discussionmentioning

confidence: 85%

“…et al found that patients with chronic liver disease (CLD) have double the risk of venous thromboembolism (VTE) compared to those without CLD. 8 Traumatic injury is a major risk factor for VTE by completing Virchow's triad with the addition of endothelial injury and/or venous stasis secondary to immobility. 9 As such, the use of VTE chemoprophylaxis (vCP) in trauma patients is crucial.…”

Section: Introductionmentioning

confidence: 99%

“…et al found that patients with chronic liver disease (CLD) have double the risk of venous thromboembolism (VTE) compared to those without CLD. 8…”

Section: Introductionmentioning

confidence: 99%

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Trauma Patients With Cirrhosis Have a Similar Risk of Unplanned Operation and Decreased Associated Risk of Mortality With Venous Thromboembolism Chemoprophylaxis

Alvarez

Grigorian

Kuza

et al. 2023

The American Surgeon™

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Introduction Patients with cirrhosis have an increased risk of complications after trauma, including bleeding, unplanned operations, and death. The benefit of venous thromboembolism (VTE) chemoprophylaxis in trauma patients with cirrhosis (CTPs) is not clear, especially since cirrhotic patients are hypercoagulable. We hypothesized that CTPs receiving VTE chemoprophylaxis (vCP) have a lower risk of death with no increased risk for unplanned operations compared to patients with cirrhosis not receiving vCP. Methods The 2017-2019 TQIP database was queried for patients with cirrhosis. Patients on outpatient anticoagulant therapy or with a history of bleeding diathesis, interhospital transfers, severe head injury, deaths < 72 hours, and hospitalization < 2 days were excluded. A multivariable logistic regression analysis was performed. Results From 10,011 CTPs, 6,350 (63.4%) received vCP. Compared to patients without vCP, the vCP group had decreased mortality (4.5% vs. 5.5%, P = 0.03) but a similar rate of unplanned operations (1% vs. 0.6%, P = 0.07). This persisted on multivariable analysis, with a decreased associated risk of mortality (OR 0.54, CI 0.42-0.69, P < 0.001), and a similar risk of unplanned operation ( P = 0.85). Conclusion CTPs received VTE chemoprophylaxis in under two-thirds of cases. On multivariable analysis, vCP was associated with a decreased risk of mortality and a similar risk of unplanned operations. These findings suggest that vCP appears safe. Further investigation is needed to confirm this finding.

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Section: Discussionmentioning

confidence: 85%

Section: Introductionmentioning

confidence: 99%

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Trauma Patients With Cirrhosis Have a Similar Risk of Unplanned Operation and Decreased Associated Risk of Mortality With Venous Thromboembolism Chemoprophylaxis

Alvarez

Grigorian

Kuza

et al. 2023

The American Surgeon™

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“…conducted a meta-analysis on the epidemiology of VTE in chronic liver disease (CLD). The pooled incidence and prevalence of VTE were 1.07% (95% CI: 0.80–1.38) per year, and 1.10% (95% CI: 0.85–1.38) per year, respectively [32]. In the study by Dabbagh et al ., the incidence of VTE though higher in Child–Pugh C, was not clinically significant, with similar incidence seen across all International Normalized Ratio quartiles [33].…”

Section: Discussionmentioning

confidence: 99%

“…This explains the unexpectedly lower incidence of VTE due to a perilously rebalanced hemostasis in cirrhosis. Subhani et al reported that hospitalized patients with CLD not on VTE prophylaxis were 2.78 times (relative risk 2.78, 95% CI: 1.11, 6.98) more likely to have VTE during hospital stay compared to those on VTE prophylaxis [32]; however, they analyzed data from only two studies. The present meta-analysis did not show the benefit of anticoagulation in reducing the incidence of VTE in hospitalized patients with cirrhosis.…”

Section: Discussionmentioning

confidence: 99%

Outcome of pharmacological thromboprophylaxis in hospitalized patients with cirrhosis – a systematic review and meta-analysis

Giri

Singh

Varghese³

et al. 2023

European Journal of Gastroenterology &Amp; Hepatology

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Background Portal hypertension in cirrhosis brings about a complex interplay in the risks of bleeding and thrombosis. It is unclear whether hospitalized patients with cirrhosis need pharmacological prophylaxis for venous thromboembolism (VTE), as it may increase the risk of bleeding. We aimed to compare the outcome of hospitalized patients with cirrhosis with and without pharmacological thromboprophylaxis. Methods A comprehensive search of three databases was conducted from inception to August 2022 for studies comparing the outcome of hospitalized patients with cirrhosis with and without pharmacological prophylaxis for VTE. Odds ratios (OR) with 95% confidence intervals (CIs) were calculated for the outcomes of VTE or bleeding. Results Overall, 12 studies were included in the final analysis. The pooled incidence of VTE in patients with and without thromboprophylaxis was 1.9% (95% CI: 0.8-2.9) and 1.9% (95% CI: 0.9-2.9), respectively. The odds of VTE were comparable between the groups with OR 1.11 (95% CI: 0.76-1.62). The pooled incidence of bleeding events in patients with and without thromboprophylaxis was 6.7% (95% CI: 3.6-9.8) and 10.4% (95% CI: 6.6-14.1), respectively. There was no significant difference in the odds of overall bleeding (OR 0.68; 95% CI: 0.30-1.52) or major bleeding (OR 1.18; 95% CI: 0.55-2.56) between the groups. There was no significant difference in the relative effects on sensitivity analysis. Conclusion The present analysis could not demonstrate the benefit of pharmacological thromboprophylaxis in reducing in-hospital VTE in patients with cirrhosis. Future studies are required to assess the role of risk prediction models in hospitalized patients with cirrhosis.

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Impact of Cirrhosis Etiology on the Risk for Venous Thromboembolism

Pemmasani,

Tremaine,

Karagozian

et al. 2024

Dig Dis Sci

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

Cited by 7 publications

References 68 publications

Trauma Patients With Cirrhosis Have a Similar Risk of Unplanned Operation and Decreased Associated Risk of Mortality With Venous Thromboembolism Chemoprophylaxis

Trauma Patients With Cirrhosis Have a Similar Risk of Unplanned Operation and Decreased Associated Risk of Mortality With Venous Thromboembolism Chemoprophylaxis

Outcome of pharmacological thromboprophylaxis in hospitalized patients with cirrhosis – a systematic review and meta-analysis

Impact of Cirrhosis Etiology on the Risk for Venous Thromboembolism

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