The risk of venous thromboembolism in patients with cirrhosis

Pasquale Ambrosino; Luciano Tarantino; Giovanni Di Minno; Mariano Paternoster; Vincenzo Graziano; Maurizio Petitto; Aurelio Nasto; Matteo Nicola Dario Di Minno

doi:10.1160/TH16-06-0450

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 2017; 117(01): 139-148
DOI: 10.1160/TH16-06-0450

Stroke, Systemic or Venous Thromboembolism

Schattauer GmbH

The risk of venous thromboembolism in patients with cirrhosis

A systematic review and meta-analysis

Pasquale Ambrosino

¹Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy

,

Luciano Tarantino

²Department of Surgery, Interventional Hepatology Unit, Andrea Tortora Hospital, Pagani, Italy

,

Giovanni Di Minno

¹Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy

,

Mariano Paternoster

³Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy

,

Vincenzo Graziano

³Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy

,

Maurizio Petitto

¹Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy

,

Aurelio Nasto

⁴Department of Surgery, Unit of General Surgery and Oncology, Andrea Tortora Hospital, Pagani, Italy

,

Matteo Nicola Dario Di Minno

⁵Department of Advanced Biomedical Sciences, Division of Cardiology, Federico II University, Naples, Italy

⁶Centro Cardiologico Monzino, IRCCS, Milan, Italy

› Author Affiliations

Abstract

Summary

Some studies suggest that patients with cirrhosis have an increased risk of deep venous thrombosis (DVT) and pulmonary embolism (PE). Unfortunately, available data on this association are contrasting. It was the objective of this study to perform a systematic review and meta-analysis of literature to evaluate the risk of venous thromboembolism (VTE) associated with cirrhosis. Studies reporting on VTE risk associated with cirrhosis were systematically searched in the PubMed, Web of Science, Scopus and EMBASE databases. Eleven studies (15 data-sets) showed a significantly increased VTE risk in 695,012 cirrhotic patients as compared with 1,494,660 non-cirrhotic controls (OR: 1.703; 95 %CI: 1.333, 2.175; P<0.0001). These results were confirmed when specifically considering the risk of DVT (7 studies, OR: 2.038; 95 %CI: 1.817, 2.285; P<0.0001) and the risk of PE (5 studies, OR: 1.655; 95 %CI: 1.042, 2.630; p=0.033). The increased VTE risk associated with cirrhosis was consistently confirmed when analysing nine studies reporting adjusted risk estimates (OR: 1.493; 95 %CI: 1.266, 1.762; p<0.0001), and after excluding studies specifically enrolling populations exposed to transient risk factors for VTE (OR: 1.689; 95 %CI: 1.321, 2.160; p<0.0001). Meta-regression models suggested that male gender may significantly impact on the risk of VTE associated with cirrhosis. Results of our meta-analysis suggest that cirrhotic subjects may exhibit an increased risk of VTE. This should be considered to plan specific prevention strategies in this clinical setting.

Supplementary Material to this article is available online at www.thrombosis-online.com.

Keywords

Deep venous thrombosis - pulmonary embolism - thromboembolism - thrombosis - cirrhosis

Full Text

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