Venous Thromboembolism in Patients with Liver Cirrhosis: Findings from the RIETE (Registro Informatizado de la Enfermedad TromboEmbolica) Registry

Behnood Bikdeli; David Jiménez; Guadalupe Garcia-Tsao; Raquel Barba; Carme Font; María del Carmen Díaz-Pedroche; Lucia Mazzolai; Derek Henry Wallace Little; Antonella Tufano; Alfonso J. Tafur; Deborah Siegal; Gregory Y.H. Lip; Manuel Monreal; for the RIETE Investigators

doi:10.1055/s-0039-1697682

Seminars in Thrombosis and Hemostasis, Table of Contents

Semin Thromb Hemost 2019; 45(08): 793-801
DOI: 10.1055/s-0039-1697682

Review Article

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Venous Thromboembolism in Patients with Liver Cirrhosis: Findings from the RIETE (Registro Informatizado de la Enfermedad TromboEmbolica) Registry

Behnood Bikdeli

¹Division of Cardiology, Department of Medicine, NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, New York

²Center for Outcomes Research & Evaluation, Yale School of Medicine, New Haven, Connecticut

³Cardiovascular Research Foundation, New York, New York

,

David Jiménez

⁴Department of Respiratory, Hospital Ramón y Cajal, Madrid, Spain

⁵Department of Medicine, Universidad de Alcalá (IRYCIS), Madrid, Spain

,

Guadalupe Garcia-Tsao

⁶Section of Digestive Diseases, Department of Medicine, Yale School of Medicine, New Haven, Connecticut

,

Raquel Barba

⁷Department of Internal Medicine, Fundación Hospital Alcorcón, Madrid, Spain

,

Carme Font

⁸Department of Medical Oncology, Hospital Clínic, Barcelona, Spain

,

María del Carmen Díaz-Pedroche

⁹Department of Internal Medicine, Hospital Universitario de Octubre, Madrid, Spain

,

Lucia Mazzolai

¹⁰Department of Angiology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland

,

Derek Henry Wallace Little

¹¹Department of Medicine, McMaster University, Hamilton, Ontario, Canada

,

Antonella Tufano

¹²Regional Reference Centre for Coagulation Disorders, Department of Clinical Medicine and Surgery, Federico II, University Hospital, Naples, Italy

,

Alfonso J. Tafur

¹³Department of Medicine, Vascular Medicine, NorthShore University HealthSystem, University of Chicago, Chicago, Illinois

,

Deborah Siegal

¹¹Department of Medicine, McMaster University, Hamilton, Ontario, Canada

,

Gregory Y.H. Lip

¹⁴Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, United Kingdom

¹⁵Thrombosis Research Unit, Aalborg University, Aalborg, Denmark

,

Manuel Monreal

¹⁶Department of Medicine, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain

¹⁷Department of Medicine, Universidad Católica de Murcia, Murcia, Spain

,

for the RIETE Investigators

› Author Affiliations

Abstract

Patients with cirrhosis are not only at an increased risk of bleeding but also at risk of venous thromboembolism (VTE). We sought to determine the clinical characteristics, management, and outcomes after VTE in patients with cirrhosis. We used the data from RIETE (Registro Informatizado de la Enfermedad TromboEmbolica), an international registry of patients with VTE, to compare the outcomes in patients with and without cirrhosis. Main outcomes included all-cause mortality, pulmonary embolism (PE)-related mortality, recurrent VTE, and bleeding. Among 43,611 patients with acute VTE, 187 (0.4%) had cirrhosis. Of these, 184 (98.4%) received anticoagulation for a median of 109 days (interquartile range [IQR]: 43–201 days), most commonly with enoxaparin (median dose: 1.77 [IQR: 1.38–2.00] mg/kg/day). Compared with patients without cirrhosis, those with cirrhosis had a higher rate of all-cause mortality (10.7 vs. 3.4%; odds ratio [OR]: 3.41; 95% confidence interval [CI]: 2.03–5.46) and fatal bleeding (2.1 vs. 0.2%; OR: 13.94; 95% CI: 3.65–37.90) but similar rates of fatal PE (0.5 vs. 0.5%; OR: 1.17; 95% CI: 0.03–6.70). Patients with cirrhosis had a higher rate of all-cause mortality per 100 patient-years of follow-up (58.9 vs. 16.0; hazard ratio [HR]: 3.70; 95% CI: 2.69–4.91). One-year hazard ratio of clinically relevant bleeding (HR: 2.86; 95% CI: 1.91–4.27), fatal bleeding (HR: 8.51; 95% CI: 3.5–20.7), or recurrent VTE (HR: 2.08; 95% CI: 1.00–4.36) was higher in patients with cirrhosis. Cirrhosis is a challenging comorbidity in patients with VTE. Most patients were treated with anticoagulation and had an elevated risk of recurrence, similar risk of fatal PE, and a very high risk of bleeding including fatal bleeds.

Keywords

venous thromboembolism - cirrhosis - bleeding

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References

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Supplementary Material

Supplementary Material