The risk of venous thromboembolism in patients with hepatitis C

Ambrosino, Pasquale; Tarantino, L.; Criscuolo, Livio; Nasto, Aurelio; Celentano, Aldo; Minno, Matteo Nicola Dario Di

doi:10.1160/th16-03-0185

Cited by 25 publications

(16 citation statements)

References 39 publications

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“…aPL may easily alter this unstable balance, thus leading to thrombotic complications, as documented in hepatitis B and C patients with aPL positivity (50). In a recent meta-analysis, we have also documented an increased thrombotic risk in HCV patients, regardless the severity of liver dysfunction (52). Thus, a direct viral action could also be hypothesized, but this could only partially explain the increased thromboembolic risk associated with cirrhosis because limited to cases with viral aetiology.…”

Section: Discussionmentioning

confidence: 79%

The risk of venous thromboembolism in patients with cirrhosis

Ambrosino¹,

Tarantino²,

Minno³

et al. 2017

Thromb Haemost

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166

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Some studies suggest that patients with cirrhosis have an increased risk of deep venous thrombosis (DVT) and pulmonary embolism (PE). Unfortunately, available data on this association are contrasting. It was the objective of this study to perform a systematic review and meta-analysis of literature to evaluate the risk of venous thromboembolism (VTE) associated with cirrhosis. Studies reporting on VTE risk associated with cirrhosis were systematically searched in the PubMed, Web of Science, Scopus and EMBASE databases. Eleven studies (15 data-sets) showed a significantly increased VTE risk in 695,012 cirrhotic patients as compared with 1,494,660 non-cirrhotic controls (OR: 1.703; 95 %CI: 1.333, 2.175; P<0.0001). These results were confirmed when specifically considering the risk of DVT (7 studies, OR: 2.038; 95 %CI: 1.817, 2.285; P<0.0001) and the risk of PE (5 studies, OR: 1.655; 95 %CI: 1.042, 2.630; p=0.033). The increased VTE risk associated with cirrhosis was consistently confirmed when analysing nine studies reporting adjusted risk estimates (OR: 1.493; 95 %CI: 1.266, 1.762; p<0.0001), and after excluding studies specifically enrolling populations exposed to transient risk factors for VTE (OR: 1.689; 95 %CI: 1.321, 2.160; p<0.0001). Meta-regression models suggested that male gender may significantly impact on the risk of VTE associated with cirrhosis. Results of our meta-analysis suggest that cirrhotic subjects may exhibit an increased risk of VTE. This should be considered to plan specific prevention strategies in this clinical setting.

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Section: Discussionmentioning

confidence: 79%

The risk of venous thromboembolism in patients with cirrhosis

Ambrosino¹,

Tarantino²,

Minno³

et al. 2017

Thromb Haemost

Self Cite

166

137

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“…Clinical studies have found that patients with cirrhosis are not protected against thrombotic events . Moreover, de novo portal vein thrombosis has been associated with high TG in the presence of TM .…”

Section: Discussionmentioning

confidence: 99%

Increased factor VIII plays a significant role in plasma hypercoagulability phenotype of patients with cirrhosis

Sinegre

Duron

Lecompte

et al. 2018

Journal of Thrombosis and Haemostasis

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Background In cirrhosis, thrombin generation (TG) studied in the presence of thrombomodulin (TM) indicates plasma hypercoagulability. Although the role of protein C (PC) deficiency has been investigated, the influence of an increase in the factor VIII level has never been addressed. Objectives We investigated the roles of high FVIII and low PC levels in increased TG in the presence of TM. Methods Blood samples were prospectively collected from 35 healthy controls and 93 patients with cirrhosis (Child-Turcotte-Pugh [CTP]-A, n = 61; CTP-B, n = 19; and CTP-C, n = 13) and FVIII levels > 150% (n = 48) and/or PC levels < 70% (n = 88). TG was performed with tissue factor (5 pm), phospholipids, and TM (4 nm). FVIII and PC levels were normalized by adding an inhibitory anti-FVIII antibody and exogenous PC, respectively. Results The endogenous thrombin potential (ETP) in the presence of TM was higher in patients than in controls. After FVIII normalization, the ETP (median) decreased from 929 nm min to 621 nm min (CTP-A), 1122 nm min to 1082 nm min (CTP-B), and 1221 nm min to 1143 nm min (CTP-C); after PC normalization, it decreased from 776 nm min to 566 nm min (CTP-A), 1120 nm min to 790 nm min (CTP-B), and 995 nm min to 790 nm min (CTP-C). The ETP was reduced by 17% and 30%, respectively, but normal TG was not restored. When both FVIII and PC levels were normalized, the ETP decreased from 929 nm min to 340 nm min (CTP-A), 1122 nm min to 506 nm min (CTP-B), and 1226 nm min to 586 nm min (CTP-C), becoming similar to control levels. Conclusion Cirrhosis-induced plasma hypercoagulability, as demonstrated in these experimental conditions, can be partly explained by opposite changes in two factors: PC level (decrease) and FVIII level (increase).

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“…The finding is comparable with other systematic reviews, which revealed a high prevalence of thrombotic events in viral diseases. 42 – 45 This high prevalence of thrombotic events could probably be due to the inflammatory process, cytokine storm, lung injury, and endothelial injury that increase the risk of hypercoagulable state in hospitalized COVID-19 patients. 46 Subgroup analysis based on patient characteristics revealed that the highest incidence of thrombotic events was observed in patients admitted to the intensive care unit (50%) (95% CI: 32–68) relative to patients admitted in medical wards.…”

Section: Discussionmentioning

confidence: 99%

Prevalence and Risk Factors of Thromboembolism among Patients With Coronavirus Disease-19: A Systematic Review and Meta-Analysis

Gelaw

Tegegne

Degu

et al. 2020

Clin Appl Thromb Hemost

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Emerging evidence shows that the recent pandemic of coronavirus disease 19 (COVID-19) is characterized by coagulation activation and endothelial dysfunction. This increases the risk of morbidity, mortality and economic loss among COVID-19 patients. Therefore, there was an urgent need to investigate the extent and risk factors of thromboembolism among COVID-19 patients. English-language based databases (PubMed, Cumulative Index to Nursing and Allied Health Literature, EMBASE, and Cochrane library) were exhaustively searched to identify studies related to prevalence of thromboembolism among hospitalized COVID-19 patients. A random-effects model was employed to estimate the pooled prevalence of thromboembolism. The pooled prevalence of thrombotic events was computed using STATA 16.0 software. Heterogeneity analysis was reported using I2. A total of 19 studies with 2,520 patients with COVID-19 were included. The pooled prevalence of thrombotic events of hospitalized patients with COVID-19 was 33% (95% CI: 25-41%, I2 = 97.30%, p < 0.001) with a high degree of heterogeneity across studies. Elevated D-dimer hospitalized in the intensive care unit and being under mechanical ventilation were the most frequently associated factors for the development of thrombotic events. The pooled prevalence of thrombotic events in COVID-19 patients was 33%. The prevalence of thrombotic event is variables on the basis of study design and study centers. Several risk factors such as, elevated D-dimer, hospitalized in the intensive care unit and being under mechanical ventilation, were the most frequently reported risk factors identified. Therefore, healthcare professionals should consider these risk factors to optimally manage thromboembolism in COVID-19 patients.

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The risk of venous thromboembolism in patients with hepatitis C

Cited by 25 publications

References 39 publications

The risk of venous thromboembolism in patients with cirrhosis

The risk of venous thromboembolism in patients with cirrhosis

Increased factor VIII plays a significant role in plasma hypercoagulability phenotype of patients with cirrhosis

Prevalence and Risk Factors of Thromboembolism among Patients With Coronavirus Disease-19: A Systematic Review and Meta-Analysis

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