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Impact of Cirrhosis Etiology on the Risk for Venous Thromboembolism

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Abstract

Background

Cirrhosis is associated with an increased risk for both bleeding and venous thromboembolic (VTE) complications. The data regarding the impact of etiology of cirrhosis on VTE risk is poorly understood.

Methods

In this retrospective observational analysis of the US Nationwide readmissions database 2019, we identified hospitalized patients who had cirrhosis from alcohol, viral, or nonalcoholic steatohepatitis (NASH) etiologies. We identified patients who had acute VTE, chronic/history of VTE, and portal venous thrombosis (PVT). Overall VTE risk was defined as the composite of acute and chronic VTE or PVT. The impact of etiology of cirrhosis on the crude and risk adjusted rates of VTE and PVT was studied.

Results

Of 432,383 patients with cirrhosis, 41.4% patients had NASH-cirrhosis, 39.7% had alcohol-related cirrhosis, and 18.9% had viral cirrhosis. The overall VTE rate was highest in patients with NASH cirrhosis (10.8%) followed by viral cirrhosis (9.7%) and alcohol-related cirrhosis (7.5%; P < 0.001). Similar results were observed for acute and chronic VTE. After risk adjustment, patients with NASH (OR 1.48 95% CI 1.42–1.54) and viral cirrhosis (OR 1.22 95% CI 1.17–1.29) had significantly higher overall VTE risk compared with alcohol-related cirrhosis. When separately evaluated, the adjusted risk for acute and chronic VTE was similar between patients with alcohol-related and viral cirrhosis but higher with NASH cirrhosis. PVT rate was highest with viral cirrhosis (4.3%) followed by NASH (2.8%) and alcohol-related cirrhosis (2.4%; P < 0.001). The adjusted risk of PVT was higher with viral (OR 1.61 95% CI 1.50–1.72) and NASH cirrhosis (OR 1.41 95% CI 1.31–1.52).

Conclusion

NASH cirrhosis was associated with a higher VTE risk compared with alcohol-related and viral etiologies. As NASH cirrhosis increases in prevalence as the major etiology of cirrhosis, it is important to understand the increased VTE risk associated with this condition to improve management strategies and patient outcomes.

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Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, SUNY Upstate Medical University, 750 E Adam St, Syracuse, NY, 13202, USA

    Gayatri Pemmasani & Savio John

  2. Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA

    William Tremaine

  3. Division of Gastroenterology and Hepatology, Tufts University School of Medicine, Boston, MA, USA

    Raffi Karagozian

Authors
  1. Gayatri Pemmasani
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  2. William Tremaine
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  4. Savio John
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Contributions

GP: design, data acquisition and analysis, interpretation, prepared initial draft and final manuscript. WT: data and results interpretation, critical review of draft manuscript and final approval; RK: data and results interpretation, critical review of draft manuscript and final approval; SJ: study design, data and results interpretation, critical review of draft manuscript and final approval.

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Correspondence to Gayatri Pemmasani.

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None of the authors have any related conflicts of interest.

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As this study used only data that was previously de-identified and available from a publicly available database, Institutional Review Board approval was not required.

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Savio John MD.

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Pemmasani, G., Tremaine, W., Karagozian, R. et al. Impact of Cirrhosis Etiology on the Risk for Venous Thromboembolism. Dig Dis Sci (2024). https://doi.org/10.1007/s10620-024-08440-7

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