Thromboembolic events in prospectively enrolled series of patients with cirrhosis followed for one year

Introduction

Coagulation in cirrhosis involves a complex imbalance between procoagulant and anticoagulant factors due to liver dysfunction. This results in a delicate hemostatic equilibrium that increases the risk of both bleeding and thrombosis.

Aim

To analyze the occurrence of thromboembolic events in a prospective series of patients with liver cirrhosis, and to assess patients’ characteristics.

Materials and Methods

We prospectively enrolled 188 patients with cirrhosis admitted to our gastrointestinal ward (December 2021-December 2022). We evaluated general and liver disease-related characteristics as well as the incidence of venous thromboembolism (VTE), and death during the first year following hospital admission.

Results

Median age was 63 years, and 72.9% were males. The primary cause of hospitalization was acute decompensation (n=101, 53.7%), followed by hepatocellular carcinoma (n=34, 18.1%) or liver-related elective diagnostic-therapeutic procedures (28, 14.9%). Twenty-five (13.3%) patients were admitted due to non-liver related events. The median length of hospitalization was 9 days (IQR 5-14). Most of patients had decompensated cirrhosis (Child-Pugh B: 41.5%; Child-Pugh C: 26.6%), with median MELD-Na=14, and clinically significant portal-hypertension (CSPH) in 148 (78.7%). Sixty-two (32.9%) patients had hepatocellular carcinoma. Thirty-one patients (16.5%) were on anticoagulants. During a 1-year follow-up, three (1.6%) patients experienced VTE while 26 (13.8%) patients had variceal bleeding. Overall mortality was 42.0% (n=79). Padua and Improve-VTE risk scores, MELD-Na, Child-Pugh class, and presence of CSPH were no different between patients with or without VTE. A competitive-risk model focused on experiencing VTE and risk of death and bleeding as competing events showed no significant association between VTE and use of anticoagulant, Charlson comorbidity index, CSPH, male gender, HCC, length of hospitalization and Improve-VTE, Padua and MELD-Na scores.

Conclusions

VTE is a rare event in patients with cirrhosis, occurring in only 1.6% of prospectively evaluated population, and no significant association between VTE and various risk factors was identified.