Reuters Health Information (2010-06-01): Younger cirrhosis inpatients at risk for venous thromboembolism
Younger cirrhosis inpatients at risk for venous thromboembolism
Last Updated: 2010-06-01 17:56:28 -0400 (Reuters Health)
NEW YORK (Reuters Health) - Hospitalized cirrhotics are at increased risk for venous thromboembolism (VTE) up until age 45 but not afterward, a new study suggests.
Patients hospitalized with cirrhosis "should be considered for VTE prophylaxis," especially those younger than 45 years, Dr. Harry Wu and Dr. Geoffrey C. Nguyen conclude in an article in Clinical Gastroenterology and Hepatology, published online May 26th.
Liver disease can both increase and decrease the risk of VTE due to its effects on the coagulation cascade, the clinicians from Mount Sinai Hospital and the University of Toronto in Ontario, Canada, note in their report.
Using data from the Nationwide Inpatient Sample (1998-2006), they compared the prevalence of VTE in hospitalized patients with and without cirrhosis. Their analysis included 408,253 admissions with compensated cirrhosis, 241,626 admissions for decompensated cirrhosis and 575,057 admissions without liver disease.
Patients with compensated cirrhosis (mean age 58.5 years) and decompensated cirrhosis (mean age 57.3 years) were older than comparison patients (54.1 years, p < 0.001), and more of them were men and Hispanic.
The prevalence of VTE was 8.1 and 8.2 per 1000 patient discharges in patients with compensated and decompensated cirrhosis, respectively, compared with 7.6 in controls.
On multivariate analysis, the cirrhotics were at higher risk of VTE up until age 45; the odds ratios were 1.23 with compensated cirrhosis and 1.39 with decompensated cirrhosis, compared with patients without cirrhosis.
After age 45, the adjusted odds of VTE was marginally lower in compensated cirrhotics relative to non-cirrhotics (OR, 0.90) and there was no difference in adjusted odds of VTE between those with decompensated cirrhosis and control patients (OR, 0.97).
The presence of VTE increased the risk of premature death in all three groups. In patients without liver cirrhosis, the odds ratio was 2.77; it was 2.16 in patients with compensated cirrhosis and 1.66 in patients with decompensated cirrhosis.
The average hospital stay for patients with compensated cirrhosis was 14.4 days if they had VTE versus 6.5 days if they did not. Among patients with decompensated cirrhosis, mean length of hospital stay was 14.9 days with VTE and 7.4 days without VTE.
On multivariate analysis, VTE was associated with a 103% increase in length of stay among patients with compensated cirrhosis and an 86% increase in those with decompensated cirrhosis.
Drs. Wu and Nguyen say the risks and benefits of VTE prophylaxis in cirrhotic patients are not clear. In a recent meta-analysis of medical inpatients, VTE prophylaxis reduced the absolute risk by 1.36%. The number needed to treat was 74. There was no increased risk of serious bleeding and a 1.73% increased risk of minor bleeding.
"Given that patients with cirrhosis are at higher risk of VTE, at least until the age of 45 years, this benefit would likely be greater," they write.
Based on the current findings, the researchers think VTE prophylaxis "should be considered in inpatients with cirrhosis, especially those under the age of 45 years. "For patients 45 and older, for whom there is no demonstrable increased risk of VTE over the general population, the risks and benefits of medical VTE prophylaxis should be weighed on a case-by-case basis," they advise.
Clin Gastro Hepatol 2010.