PURPOSE:Chronic Liver Disease CLD is associated with Coagulopathy manifested by prolonged International Normalized Ratio INR. Whether Coagulopathy protects against venous thromboembolism VTE is unknown. We sought to evaluate the incidence of VTE among hospitalized patients with CLD.
METHODS:This is a retrospective cohort study performed at a tertiary university hospital. Consecutive adult patients admitted over a 7 year period with diagnosis of CLD were included. Exclusion criteria were pregnancy, hereditary hypercoagulable state, and documented deep vein thrombosis DVT or pulmonary embolism PE upon admission. The primary end point was the development of any VTE event defined as any new DVT or PE during hospital stay. Portal vein thrombosis was excluded. Patients were divided into quartiles according to admission INR. VTE rates were compared among INR quartiles. Uni-variate and Multi-variate analyses were performed to evaluate for predictors of VTE. Appropriate parametric, nonparametric or chi-square tests were used for comparison of Continuous or categorical variables.
RESULTS:Over the allotted 7 year period, we included 189 patients that satisfied the study inclusion and exclusion criteria. Of these 11 had new DVT and 2 had PE yielding a VTE incidence of 5.8%. There were no differences in Univariate analysis between the VTE and non-VTE groups (Table 1). Most of VTE events (8/11; 72.7%) occurred in the three prolonged INR Quartiles (INR >1.4). Indeed, 2 (18.2%) VTE events occurred in the INR>2.2 quartile (Figure 1). We did not find any independent predictors for VTE on Multi-variate Analysis.
CONCLUSION:VTE is more common among CLD patients than previously reported in literature. Most events in our study occurred in the prolonged INR quartiles. High INR did not protect against VTE in this group. In contrary to previously reported literature, low albumin was not an independent predictor for VTE.
CLINICAL IMPLICATIONS:Clinicians need to be aware that high INR does not protect against VTE in CLD patients. Further studies are necessary to discern the specific risk factors, predictors and appropriate prophylaxis for VTE among patients with chronic Liver disease.
DISCLOSURE:Ousama Dabbagh, No Financial Disclosure Information; No Product/Research Disclosure Information