Abstract
Purpose
Patients with liver cirrhosis are generally considered to be “auto-anticoagulated” because of coagulopathy and thrombocytopenia. However, deep vein thrombosis (DVT) has been reported in patients with liver cirrhosis. The objectives of this study were to know the prevalence of DVT among cirrhotic patients and to compare clinical pictures between cirrhotic patients with and without DVT.
Methods
A case–control study was performed on the basis of medical record data of patients with liver cirrhosis admitted between August 2004 and July 2007 in Medistra hospital in Jakarta. Diagnosis of DVT was established by duplex Doppler ultrasonography of the lower extremities. Patients with splanchnic thrombosis were excluded from this study. Diagnosis of liver cirrhosis was based on history and clinical manifestation, consistent with liver cirrhosis and confirmed by ultrasonography or computed tomography.
Results
A total of 256 patients with liver cirrhosis were included in this study; 164 (64.1%) among them were men. Patients’ mean age was 60.5 ± 12.5 years, ranging from 16 to 88 years. Viral hepatitis accounted for 74.6% of patients with liver cirrhosis. DVT was found in 12 (4.7%) patients. There was no significant laboratory difference between cirrhotic patients with and without DVT (serum albumin, platelet count, aminotransferases, γ-glutamyl transpeptidase, alkaline phosphatase, total bilirubin levels, and prothrombin time). Diabetes mellitus was significantly higher in the DVT group than that in the control group (66.6 vs. 34.0%, P = 0.025). Multivariate analysis confirmed diabetes mellitus as an independent risk factor for the occurrence of DVT (odds ratio = 4.26; 95% confidence interval = 1.206–15.034; P = 0.024).
Conclusions
The prevalence of DVT in patients with liver cirrhosis was 4.7%, and Deep vein thrombosis is not a rare condition in cirrhotic patients with coagulopathy and warrants further studies on the mechanisms and prevention.
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References
Anderson FA, Spencer FA. Risk factors for venous thromboembolism. Circulation. 2003;107 Suppl I :9–16
Alikhan R, Cohen AT, Combe S, et al. Risk factors for venous thromboembolism in hospitalized patients with acute medical illness: analysis of the MEDENOX Study. Arch Intern Med 2004;164:963–968
Zakai NA, Wright J, Cushman M. Risk factors for venous thrombosis in medical inpatients: validation of a thrombosis risk score. J Thromb Haemost 2004;2:2156–2161
Bovill LG. Liver disease. In Goodnight SH, Hathaway WE, editors. Disorders of Haemostasis and Thrombosis, a Clinical Guide. New York: McGraw Hill; 2001. 226
Abeer Khalid AG, Gader A, Mohammed AG. The liver and the haemostatic system. Saudi J Gastroenterol 2003;9:59–68
Northup PG, McMahon MM, Ruhl AP, Altschuler SE, Volk-Bednarz A, Caldwell SH. Coagulopathy does not fully protect hospitalized cirrhosis patients from peripheral venous thromboembolism. Am J Gastroenterol 2006;101:1524–1528
Senzolo M, Burra P, Cholongitas E, Burroughs AK. New insights into the coagulopathy of liver disease and liver transplantation. World J Gastroenterol 2006;12:7725–36
Caldwell SH, Hoffman M, Lisman T, Macik G, Northup PG, Reddy KR, et al. Coagulation disorders and hemostasis in liver disease: pathophysiology and critical assessment of current management. Hepatology. 2006;44:1039–1046
Protein C deficiency. In Goodnight SH, Hathaway WE, editors. Disorders of Haemostasis and Thrombosis, a Clinical Guide. New York: McGraw Hill; 2001. 369
Valla DC. Thrombosis and anticoagulation in liver disease. Hepatology. 2008;47:1384–1393
Petrauskiene V, Falk M, Waernbaum I, Norberg M, Eriksson JW. The risk of venous thromboembolism is markedly elevated in patients with diabetes. Diabetologia. 2005;48:1017–1021
Ray JG, Lonn E, Yi Q, Rathe A, Sheridan P, Karon C, et al. Venous thromboembolism in association with features of the metabolic syndrome. Q J Med 2007;100:679–684
Lee AYY. Management of thrombosis in cancer: primary prevention and secondary prophylaxis. Br J Haematol 2004;128:291–302
Northup PG, Sundaram V, Fallon MB, Reddy KR, Balogun RA, Sanyal AJ, et al. Hypercoagulation and thrombophilia in liver disease. J Thromb Haemost 2008;6:2–9
Wells PS, Hirsh J, Anderson DR, Lensing AW, Foster G, Kearon C, et al. Accuracy of clinical assessment of deep-vein thrombosis. Lancet. 1995;345:1326–1330
Cushman M. Epidemiology and risk factors for venous thrombosis. Semin Hematol 2007;44:62–99
Heit JA, Silverstein MD, Mohr DN, Petterson TM, O’Fallon WM, Melton LJ. Risk factors for deep vein thrombosis and pulmonary embolism: a population-based case–control study. Arch Int Med 2000;160:809–815
White RH, Chew HK, Zhou H, Parikh-Patel A, Harris D, Harvey D, et al. Incidence of venous thromboembolism in the year before the diagnosis of cancer in 528, 693 adults. Arch Intern Med 2005;165:1782–1787
Piccioli A, Aw Lensing, Prins MH, Falanga A, Scannapieco GL, Ieran M, et al. Extensive screening for occult malignant disease in idiopathic venous thromboembolism: a prospective randomized clinical trial. J Thromb Haemost 2004;2:884–889
Sørensen HT. Cancer and subsequent risk of venous thromboembolism. J Thromb Haemost 2006;4:527–528
Bick RL. Cancer-associated thrombosis. N Engl J Med 2003;349:109–111
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Lesmana, C.R.A., Inggriani, S., Cahyadinata, L. et al. Deep vein thrombosis in patients with advanced liver cirrhosis: a rare condition?. Hepatol Int 4, 433–438 (2010). https://doi.org/10.1007/s12072-010-9166-6
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DOI: https://doi.org/10.1007/s12072-010-9166-6