PURPOSE: Coagulation abnormalities are common in cirrhosis with the most frequent being prolongation of prothrombin time. However cirrhosis is also associated with defects in the anticoagulation system and is thus a procoagulant state as well. Though excessive bleeding is a more common in cirrhosis, the degree to which the pro-coagulant abnormalities are manifested remains uncertain. Studies have previously reported the incidence of unprovoked DVT & PE in cirrhosis to be between 0.5% and 1.9%. We studied the frequency and outcomes of venous thromboembolism (VTE) in patients with cirrhosis and specifically in the subset of cirrhotic patients who develop coagulopathy.
METHODS: Using the Nationwide Inpatient Sample 2007, patients older than 18 years, discharged with primary diagnosis of VTE and any diagnosis of cirrhosis (571.x) were identified through appropriate ICD-9-CM codes. Cirrhosis with coagulopathy was defined as cirrhotic patients with a concomitant diagnosis of secondary thrombocytopenia or coagulation defect. Outcome variables included frequency, in-hospital mortality and length of stay(LOS) of VTE in cirrhosis. Multivariate logistic regression was used to adjust for age, sex, race and other risk factors for VTE. Appropriate survey commands allowed weighting of the stratified data to give a national estimate.
RESULTS: There were 560,503 estimated adult discharges with cirrhosis in 2007. The frequency of VTE was 0.52% in cirrhotic while it was 0.92% in those without cirrhosis (adjusted OR 0.57; 95%CI 0.53-0.62) and was 0.42% in cirrhosis with coagulopathy (OR 0.29; 95%CI 0.34-0.51).In-hospital mortality with VTE was not significantly different between cirrhotic and non-cirrhotic patient. The LOS in VTE patients was 0.66 days higher if they had cirrhosis (95% CI 0.29 - 1.03 days).
CONCLUSION: Using nationally representative data, this observational study showed that frequency of VTE is significantly lower in patients with cirrhosis and even lower in cirrhosis with coagulopathy. There was no significant difference seen in mortality in VTE from cirrhosis.
CLINICAL IMPLICATIONS: The frequency of VTE in cirrhosis is lower and cirrhosis does not worsens mortality in patients with VTE.
DISCLOSURE: Gagan Kumar, No Financial Disclosure Information; No Product/Research Disclosure Information