Chest
ORIGINAL RESEARCHVENOUS THROMBOEMBOLISMCoagulopathy Does Not Protect Against Venous Thromboembolism in Hospitalized Patients With Chronic Liver Disease
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Patients
We retrospectively reviewed the charts of patients with discharge International Classification of Diseases, 9th edition. diagnosis codes corresponding to CLD and cirrhosis (571, 571.5, 571.8, and 571.9) who were admitted to a tertiary care University Hospital between January 1, 2000, and January 31, 2007. Patients were eligible for inclusion in the study if they were 18 years or older and were admitted primarily for CLD. CLD was defined based on clinical and pathologic criteria. Histologic
Results
We identified 193 patients who met the inclusion criteria and excluded three because of a lack of INR data. Data on 190 patients were included in the final analysis. The subjects were divided into quartiles separated by INR values of 1.4, 1.7, and 2.2 (Table 1). The baseline demographics were similar among the quartiles. The calculated VTE risk score was also similar, as was the number of patients with a history of VTE. In all four quartiles, the most common cause of CLD was alcohol related,
Discussion
The incidence of new VTE in our study was 6.3%. This is higher than the previously reported incidences of 1.9% and 0.5%, according to Gulley et al7 and Northup et al,8 respectively. Our study shows that elevated INR in CLD should not give clinicians a sense of security. In this study, half of cases of VTE occurred in patients with INR > 1.6, and there was still a risk of VTE with INR > 2.2. Most of our study subjects were Child-Pugh stage C, which is unique from other published reports, in
Acknowledgments
Author contributions: Dr Dabbagh: contributed to concept, design, analysis, interpretation, manuscript draft, and overall supervision.
Ms Oza: contributed to design, data collection, and review of the manuscript.
Dr Prakash: contributed to data collection and review of the manuscript.
Dr Sunna: contributed to data collection, review of the manuscript, and supervision.
Dr Saettele: contributed to analysis, interpretation, and manuscript draft and review.
Financial/nonfinancial disclosures: The
References (0)
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Thromboprophylaxis for venous thromboembolism prevention in hospitalized patients with cirrhosis: Guidance from the SSC of the ISTH
2022, Journal of Thrombosis and HaemostasisIncidence and prevalence of venous thromboembolism in chronic liver disease: A systematic review and meta-analysis
2022, Thrombosis ResearchCitation Excerpt :Singh et al. only included patients with a diagnosis of type 2 diabetes mellitus and concomitant non-alcohol fatty liver disease (NAFLD) [25]. Eighteen studies reported cumulative incidence per year [3,17,21,22,24,25,27,44–48,51,52,54,55,57–59], comprising a total of 1,628,164 participants, and 17,424 new VTE events in hospitalised CLD patients. Three studies reported incidence rate (person-years) [51,57,58].
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