Tuesday, January 18, 2011

Liver Health: Deep vein thrombosis (DVT) In Cirrhosis

A study published in the 2011 issue of the Thrombosis Journal entitled:
Concluded that cirrhotic patients are at risk for developing VTE.
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VTE Defined : "The process by which blood clots occur and travel through the veins is known as venous thromboembolism, the collective term for DVT ."
What is thrombosis?
A clot within a blood vessel is called a thrombus and the process by which it forms is known as thrombosis. It can be damaging as it might block the flow of blood. Also,part of the clot mite break away and block a blood vessel further along,cutting off the blood supply to important organs.
What Is DVT
Deep vein thrombosis (DVT) is the formation of a blood clot in one of the deep veins within the body, such as in the leg or pelvis. This kind of thrombosis can occur after surgery and may cause redness, pain and swelling.

The incidence of Venous Thromboembolism and practice of Deep Venous Thrombosis Prophylaxis in hospitalized cirrhotic patients
Cirrhotic patients are characterized by a decreased synthesis of coagulation and anticoagulation factors. The coagulopathy of cirrhotic patients is considered to be auto-anticoagulation.
Our aim was to determine the incidence and predictors of venous thromboembolism (VTE) and examine the practice of deep venous thrombosis (DVT) prophylaxis among hospitalized cirrhotic patients.
Methods: A retrospective cohort study was performed in a tertiary teaching hospital. We included all adult patients admitted to the hospital with a diagnosis of liver cirrhosis from January 1, 2009 to December 31, 2009.We grouped our cohort patients in two groups, cirrhotic patients without VTE and cirrhotic with VTE.
Results: Over one year, we included 226 cirrhotic patients, and the characteristics of both groups were similar regarding their clinical and laboratory parameters and their outcomes.
Six patients (2.7%) developed VTE, and all of the VTEs were DVT.
Hepatitis C was the most common (51%) underlying cause of liver cirrhosis, followed by hepatitis B (22%); 76% of the cirrhotic patients received neither pharmacological nor mechanical DVT prophylaxis.
Conclusion: Cirrhotic patients are at risk for developing VTE. The utilization of DVT prophylaxis was suboptimal.
Author: Abdulaziz AldawoodYaseen ArabiAbdulrahman AljumahAlawi AlSaeediAsgar RishuHasan AldorziSaad AlQahtaniMohammad AlsultanAfaf FelembanCredits/
Source: Thrombosis Journal 2011, 9:1
Additional Information:
Published online May 26th 2010 in Clinical Gastroenterology and Hepatology, Dr. Harry Wu and Dr. Geoffrey C. Nguyen conclude in an article that younger cirrhosis patients are at risk for venous thromboembolism.
Younger cirrhosis inpatients at risk for venous thromboembolism

NEW YORK (Reuters Health) –

Hospitalized cirrhotics are at increased risk for venous thromboembolism (VTE) up until age 45 but not afterward, a new study suggests. Patients hospitalized with cirrhosis patients "should be considered for VTE prophylaxis," especially those younger than 45 years, Dr. Harry Wu and Dr. Geoffrey C. Nguyen conclude in an article in Clinical Gastroenterology and Hepatology, published online May 26th. Liver disease can both increase and decrease the risk of VTE due to its effects on the coagulation cascade, the clinicians from Mount Sinai Hospital and the University of Toronto in Ontario, Canada, note in their report.

Using data from the Nationwide Inpatient Sample (1998-2006), they compared the prevalence of VTE in hospitalized patients with and without cirrhosis. Their analysis included 408,253 admissions with compensated cirrhosis, 241,626 admissions for decompensated cirrhosis and 575,057 admissions without liver disease.

Patients with compensated cirrhosis (mean age 58.5 years) and decompensated cirrhosis (mean age 57.3 years) were older than comparison patients (54.1 years, p <>

After age 45, the adjusted odds of VTE was marginally lower in compensated cirrhotics relative to non-cirrhotics (OR, 0.90) and there was no difference in adjusted odds of VTE between those with decompensated cirrhosis and control patients (OR, 0.97). The presence of VTE increased the risk of premature death in all three groups. In patients without liver cirrhosis, the odds ratio was 2.77; it was 2.16 in patients compensated cirrhosis and 1.66 in patients with decompensated cirrhosis.

The average hospital stay for patients with compensated cirrhosis was 14.4 days if they had VTE versus 6.5 days if they did not. Among patients with decompensated cirrhosis, mean length of hospital stay was 14.9 days with VTE and 7.4 days without VTE. On multivariate analysis, VTE was associated with a 103% increase in length of stay among patients with compensated cirrhosis and an 86% increase in those with decompensated cirrhosis. Drs. Wu and Nguyen say the risks and benefits of VTE prophylaxis in cirrhotic patients are not clear. In a recent meta-analysis of medical inpatients, VTE prophylaxis reduced the absolute risk by 1.36%. The number needed to treat was 74.

There was no increased risk of serious bleeding and a 1.73% increased risk of minor bleeding. “Given that patients with cirrhosis are at higher risk of VTE, at least until the age of 45 years, this benefit would likely be greater,” they write. Based on the current findings, the researchers think VTE prophylaxis "should be considered in inpatients with cirrhosis, especially those under the age of 45 years.

“For patients 45 and older, for whom there is no demonstrable increased risk of VTE over the general population, the risks and benefits of medical VTE prophylaxis should be weighed on a case-by-case basis,” they advise.

References: http://www.cghjournal.org/article/S1542-3565%2810%2900500-8/abstract

Clin Gastro Hepatol 2010.

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