Skip to main content

Advertisement

SpringerLink
Log in

Deep Vein Thrombosis and Pulmonary Embolism in Hospitalized Patients with Cirrhosis: A Nationwide Analysis

  • Original Article
  • Published:
Digestive Diseases and Sciences Aims and scope Submit manuscript

Abstract

Background and Aims

Recent studies have shown conflicting results regarding the risk of venous thromboembolism (VTE) in cirrhotics despite the often-associated coagulopathy. Our aim was to determine burden and risk factors for VTE in cirrhotics from a national sample.

Methods

Using data from the Nationwide Inpatient Sample 2005, we identified cirrhosis-related hospitalizations using appropriate discharge codes. Our outcomes of interest were deep venous thrombosis (DVT) or pulmonary embolism (PE). Cirrhotics without VTE formed the controls. Multivariate regression models were used to identify factors independently associated with VTE and the impact of VTE diagnosis on in-hospital outcomes.

Results

There were 449,798 hospitalizations for cirrhosis in 2005 of which 8,231 were for VTE (1.8%). This rate was lower than the rate for chronic hepatitis C (2.4%) or all-cause hospitalizations (3.7%). Patients with VTE were older than controls and had greater co-morbidity and were more likely to have malnutrition, parenteral nutrition, prolonged mechanical ventilation, and central venous line (CVL) placement. Complications of cirrhosis including hepatic encephalopathy, variceal bleeding, ascites, and coagulopathy were less frequent in those with VTE than controls. On multivariate regression, greater co-morbidity, black race, malnutrition, and CVL placement were independently associated with VTE. Neither DVT nor PE was associated with greater in-hospital mortality. DVT, but not PE, was associated with a 52% increase in LOS and hospitalization charges.

Conclusions

Despite the often-associated coagulopathy, VTE contributes to a significant burden in patients with cirrhosis. Efforts directed at VTE prevention in this cohort, especially high-risk patients, should be actively pursued.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Abbreviations

CI:

Confidence interval

CVL:

Central venous Line

DVT:

Deep vein thrombosis

ICD-9-CM:

International Classification of Disease, Clinical Modification, ninth revision

LOS:

Length of stay

MELD:

Model end-stage liver disease

NIS:

Nationwide Inpatient Sample

OR:

Odds ratio

PE:

Pulmonary embolism

SBP:

Spontaneous bacterial peritonitis

TPN:

Total parenteral nutrition

VTE:

Venous thromboembolism

References

  1. Samkoff JS, Comstock GW. Epidemiology of pulmonary embolism: mortality in a general population. Am J Epidemiol. 1981;114:488–496.

    PubMed  CAS  Google Scholar 

  2. Lewis WF. Utilization of short-stay hospitals. Summary of nonmedical statistics, United States-1973. Vital Health Stat. 1976;13:1–43.

    Google Scholar 

  3. Heit JA, Silverstein MD, Mohr DN, Petterson TM, O’Fallon WM, Melton LJ 3rd. Risk factors for deep vein thrombosis and pulmonary embolism: a population-based case–control study. Arch Intern Med. 2000;160:809–815.

    Article  PubMed  CAS  Google Scholar 

  4. Huerta C, Johansson S, Wallander MA, Garcia Rodriguez LA. Risk factors and short-term mortality of venous thromboembolism diagnosed in the primary care setting in the United Kingdom. Arch Intern Med. 2007;167:935–943.

    Article  PubMed  Google Scholar 

  5. Northup PG, McMahon MM, Ruhl AP, et al. Coagulopathy does not fully protect hospitalized cirrhosis patients from peripheral venous thromboembolism. Am J Gastroenterol. 2006;101:1524–1528. quiz 1680.

    Article  PubMed  Google Scholar 

  6. Sogaard KK, Horvath-Puho E, Gronbaek H, Jepsen P, Vilstrup H, Sorensen HT. Risk of venous thromboembolism in patients with liver disease: a nationwide population-based case–control study. Am J Gastroenterol. 2009;104:96–101.

    Article  PubMed  Google Scholar 

  7. Tripodi A, Primignani M, Chantarangkul V, et al. An imbalance of pro- vs anti-coagulation factors in plasma from patients with cirrhosis. Gastroenterology. 2009;137:2105–2111.

    Article  PubMed  CAS  Google Scholar 

  8. Wu H, Nguyen GC. Liver cirrhosis is associated with venous thromboembolism among hospitalized patients in a nationwide US study. Clin Gastroenterol Hepatol. 2010;8:800–805.

    Google Scholar 

  9. Heit JA, O’Fallon WM, Petterson TM, et al. Relative impact of risk factors for deep vein thrombosis and pulmonary embolism: A population-based study. Arch Intern Med. 2002;162:1245–1248.

    Article  PubMed  Google Scholar 

  10. Heit JA. The epidemiology of venous thromboembolism in the community: implications for prevention and management. J Thromb Thrombolysis. 2006;21:23–29.

    Article  PubMed  Google Scholar 

  11. Kierkegaard A, Norgren L, Olsson CG, Castenfors J, Persson G, Persson S. Incidence of deep vein thrombosis in bedridden non-surgical patients. Acta Med Scand. 1987;222:409–414.

    Article  PubMed  CAS  Google Scholar 

  12. HCUP Nationwide Inpatient Sample (NIS). Healthcare Cost and Utilization Project (HCUP). 2005. Agency for Healthcare Research and Quality, Rockville, MD. Available at: http://www.hcup-us.ahrq.gov/nisoverview.jsp. Accessed 1 June 2009.

  13. Kramer JR, Davila JA, Miller ED, Richardson P, Giordano TP, El-Serag HB. The validity of viral hepatitis and chronic liver disease diagnoses in Veterans Affairs administrative databases. Aliment Pharmacol Ther. 2008;27:274–282.

    Article  PubMed  CAS  Google Scholar 

  14. Bajaj JS, Ananthakrishnan AN, McGinley EL, Hoffmann RG, Brasel KJ. Deleterious effect of cirrhosis on outcomes after motor vehicle crashes using the Nationwide Inpatient Sample. Am J Gastroenterol. 2008;103:1674–1681.

    Article  PubMed  Google Scholar 

  15. Nguyen GC, Segev DL, Thuluvath PJ. Racial disparities in the management of hospitalized patients with cirrhosis and complications of portal hypertension: a national study. Hepatology. 2007;45:1282–1289.

    Article  PubMed  Google Scholar 

  16. Nguyen GC, Segev DL, Thuluvath PJ. Nationwide increase in hospitalizations and hepatitis C among inpatients with cirrhosis and sequelae of portal hypertension. Clin Gastroenterol Hepatol. 2007;5:1092–1099.

    Article  PubMed  Google Scholar 

  17. Deyo RA, Cherkin DC, Ciol MA. Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol. 1992;45:613–619.

    Article  PubMed  CAS  Google Scholar 

  18. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40:373–383.

    Article  PubMed  CAS  Google Scholar 

  19. Wasilewicz M, Raszeja-Wyszomirska J, Wunsch E, Wojcicki M, Milkiewicz P. Modified Charlson comorbidity index in predicting early mortality after liver transplantation. Transplant Proc. 2009;41:3117–3118.

    Article  PubMed  CAS  Google Scholar 

  20. Spencer FA, Emery C, Lessard D, et al. The Worcester venous thromboembolism study: A population-based study of the clinical epidemiology of venous thromboembolism. J Gen Intern Med. 2006;21:722–727.

    Article  PubMed  Google Scholar 

  21. Kniffin WD Jr, Baron JA, Barrett J, Birkmeyer JD, Anderson FA Jr. The epidemiology of diagnosed pulmonary embolism and deep venous thrombosis in the elderly. Arch Intern Med. 1994;154:861–866.

    Article  PubMed  Google Scholar 

  22. Oger E, Bressollette L, Nonent M, et al. High prevalence of asymptomatic deep vein thrombosis on admission in a medical unit among elderly patients. Thromb Haemost. 2002;88:592–597.

    PubMed  CAS  Google Scholar 

  23. Goldhaber SZ. Pulmonary embolism. Lancet. 2004;363:1295–1305.

    Article  PubMed  Google Scholar 

  24. Kyrle PA, Eichinger S. Deep vein thrombosis. Lancet. 2005;365:1163–1174.

    Article  PubMed  Google Scholar 

  25. White RH, Zhou H, Murin S, Harvey D. Effect of ethnicity and gender on the incidence of venous thromboembolism in a diverse population in California in 1996. Thromb Haemost. 2005;93:298–305.

    PubMed  CAS  Google Scholar 

  26. Cortelezzi A, Moia M, Falanga A, et al. Incidence of thrombotic complications in patients with haematological malignancies with central venous catheters: a prospective multicentre study. Br J Haematol. 2005;129:811–817.

    Article  PubMed  Google Scholar 

  27. van Rooden CJ, Schippers EF, Barge RM, et al. Infectious complications of central venous catheters increase the risk of catheter-related thrombosis in hematology patients: a prospective study. J Clin Oncol. 2005;23:2655–2660.

    Article  PubMed  Google Scholar 

  28. Anton N, Massicotte MP. Venous thromboembolism in pediatrics. Semin Vasc Med. 2001;1:111–122.

    Article  PubMed  CAS  Google Scholar 

  29. Kuwahara T, Asanami S, Tamura T, Kaneda S. Effects of pH and osmolality on phlebitic potential of infusion solutions for peripheral parenteral nutrition. J Toxicol Sci. 1998;23:77–85.

    PubMed  CAS  Google Scholar 

Download references

Conflict of interest

No conflicts of interest exist.

Author information

Authors and Affiliations

  1. Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, 53226, USA

    Muhammad Ali

  2. Department of Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, WI, 53226, USA

    Ashwin N. Ananthakrishnan & Kia Saeian

  3. Department of Population Health, Medical College of Wisconsin, Milwaukee, WI, 53226, USA

    Emily L. McGinley

Authors
  1. Muhammad Ali
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ashwin N. Ananthakrishnan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Emily L. McGinley
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kia Saeian
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Muhammad Ali.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ali, M., Ananthakrishnan, A.N., McGinley, E.L. et al. Deep Vein Thrombosis and Pulmonary Embolism in Hospitalized Patients with Cirrhosis: A Nationwide Analysis. Dig Dis Sci 56, 2152–2159 (2011). https://doi.org/10.1007/s10620-011-1582-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10620-011-1582-5

Keywords

Search

Navigation