Deep Vein Thrombosis and Pulmonary Embolism in Hospitalized Patients with Cirrhosis: A Nationwide Analysis

Recent studies have shown conflicting results regarding the risk of venous thromboembolism (VTE) in cirrhotics despite the often-associated coagulopathy. Our aim was to determine burden and risk factors for VTE in cirrhotics from a national sample. Using data from the Nationwide Inpatient Sample 2005, we identified cirrhosis-related hospitalizations using appropriate discharge codes. Our outcomes of interest were deep venous thrombosis (DVT) or pulmonary embolism (PE). Cirrhotics without VTE formed the controls. Multivariate regression models were used to identify factors independently associated with VTE and the impact of VTE diagnosis on in-hospital outcomes. There were 449,798 hospitalizations for cirrhosis in 2005 of which 8,231 were for VTE (1.8%). This rate was lower than the rate for chronic hepatitis C (2.4%) or all-cause hospitalizations (3.7%). Patients with VTE were older than controls and had greater co-morbidity and were more likely to have malnutrition, parenteral nutrition, prolonged mechanical ventilation, and central venous line (CVL) placement. Complications of cirrhosis including hepatic encephalopathy, variceal bleeding, ascites, and coagulopathy were less frequent in those with VTE than controls. On multivariate regression, greater co-morbidity, black race, malnutrition, and CVL placement were independently associated with VTE. Neither DVT nor PE was associated with greater in-hospital mortality. DVT, but not PE, was associated with a 52% increase in LOS and hospitalization charges. Despite the often-associated coagulopathy, VTE contributes to a significant burden in patients with cirrhosis. Efforts directed at VTE prevention in this cohort, especially high-risk patients, should be actively pursued.