Digestive Diseases and Sciences

, Volume 53, Issue 11, pp 3012–3017 | Cite as

Deep Vein Thrombosis and Pulmonary Embolism in Cirrhosis Patients

  • David Gulley
  • Evgenia Teal
  • Attaya Suvannasankha
  • Naga Chalasani
  • Suthat Liangpunsakul
Original Paper

Abstract

Background and Aims It is a commonly held notion that patients with cirrhosis do not suffer from deep vein thrombosis (DVT) or pulmonary embolism (PE) because they are naturally anticoagulated. However, to date, no studies have been carried out that objectively address this issue. We conducted a study to examine the relationship between cirrhosis and DVT/PE events. Methods A case–control study of patients seen at a tertiary care hospital was performed. Cases were hospitalized patients with biopsy and/or imaging plus clinical evidence of cirrhosis. Well-matched patients with no known evidence of cirrhosis served as controls. The DVT/PE events were identified by the international classification of disease-9 (ICD-9) codes and confirmed with radiographic/nuclear imaging. The Charlson Index was calculated to determine the comorbidity. The incidence of DVT/PE in cirrhotic patients was also compared to patients with chronic kidney disease (CKD), congestive heart failure (CHF), and solid organ cancers. Results This study consisted of 963 cirrhotics and 12,405 controls. Both the incidence of DVT/PE (1.8 vs. 0.9%, P = 0.007) and Charlson Index scores (3.2 ± 1.8 vs. 0.9 ± 1.5, P < 0.001) were higher in cirrhotics than in the controls. However, in the multivariate analysis, the presence of cirrhosis was not associated with DVT/PE [odds ratio (OR) 0.87, P = 0.06]. Partial thromboplastin time (PTT; OR 0.88, P = 0.04) and serum albumin (OR 0.47, P = 0.03) were the independent predictors of DVT/PE. The incidence of DVT/PE in cirrhotics (1.8%) was lower than that in patients with other medical illnesses: 7.1% in CKD, 7.8% in CHF, and 6.1% in cancers. Conclusion Patients with cirrhosis do not have a lower risk of DVT/PE than non-cirrhotic controls without other significant co-morbidities, such as CHF, CKD, and solid organ cancers. Partial thromboplastin time and serum albumin were found to be independently predictive of DVT/PE in cirrhotic patients.

Keywords

Cirrhosis Deep vein thrombosis Pulmonary embolism 

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Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • David Gulley
    • 1
  • Evgenia Teal
    • 2
  • Attaya Suvannasankha
    • 3
  • Naga Chalasani
    • 1
  • Suthat Liangpunsakul
    • 1
    • 4
  1. 1.Division of Gastroenterology and HepatologyIndiana University Medical CenterIndianapolisUSA
  2. 2.The Regenstrief Institute for Health CareIndianapolisUSA
  3. 3.Division of Hematology and Oncology, Department of MedicineIndiana University School of MedicineIndianapolisUSA
  4. 4.Roudebush Veterans Administration Medical CenterIndianapolisUSA

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