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Published on: June 18, 2020
Impact of Cirrhosis Etiology on the Risk for Venous Thromboembolism
Gayatri Pemmasani1, William Tremaine2, Raffi Karagozian3
1Division of Gastroenterology and Hepatology, SUNY Upstate Medical University, 750 E Adam St, Syracuse, NY, 13202, USA. gpemmasani0524@gmail.com.
Insights
Nonalcoholic steatohepatitis (NASH) cirrhosis is linked to a higher risk of venous thromboembolism (VTE) compared to alcohol-related or viral cirrhosis. Understanding this increased VTE risk in NASH cirrhosis is crucial for better patient management.
Area of Science:
- Hepatology
- Cardiovascular Medicine
- Gastroenterology
Background:
- Cirrhosis significantly elevates risks for bleeding and venous thromboembolic (VTE) events.
- The specific impact of different cirrhosis etiologies on VTE risk remains insufficiently understood.
Purpose of the Study:
- To investigate and compare the risk of VTE and portal venous thrombosis (PVT) across various cirrhosis etiologies, including nonalcoholic steatohepatitis (NASH), viral, and alcohol-related causes.
- To analyze the association between cirrhosis etiology and VTE/PVT risk using a large national database.
Main Methods:
- Retrospective analysis of the 2019 US Nationwide Readmissions Database.
- Inclusion of hospitalized patients diagnosed with cirrhosis from NASH, viral, or alcohol-related etiologies.
- Identification and comparison of rates for acute VTE, chronic VTE, and PVT across these etiological groups.
Main Results:
- Nonalcoholic steatohepatitis (NASH) cirrhosis exhibited the highest overall VTE rate (10.8%), followed by viral (9.7%) and alcohol-related (7.5%) cirrhosis.
- After risk adjustment, NASH cirrhosis (OR 1.48) and viral cirrhosis (OR 1.22) showed significantly higher VTE risk compared to alcohol-related cirrhosis.
- Viral cirrhosis had the highest PVT rate (4.3%), with both viral (OR 1.61) and NASH cirrhosis (OR 1.41) demonstrating increased adjusted risks for PVT compared to alcohol-related cirrhosis.
Conclusions:
- Nonalcoholic steatohepatitis (NASH) cirrhosis is associated with a significantly elevated risk of venous thromboembolism (VTE) compared to alcohol-related and viral etiologies.
- Given the rising prevalence of NASH as a primary cause of cirrhosis, recognizing its link to increased VTE risk is vital for refining clinical management and improving patient outcomes.
Background:
Cirrhosis is associated with an increased risk for both bleeding and venous thromboembolic (VTE) complications. The data regarding the impact of etiology of cirrhosis on VTE risk is poorly understood.
Methods:
In this retrospective observational analysis of the US Nationwide readmissions database 2019, we identified hospitalized patients who had cirrhosis from alcohol, viral, or nonalcoholic steatohepatitis (NASH) etiologies. We identified patients who had acute VTE, chronic/history of VTE, and portal venous thrombosis (PVT). Overall VTE risk was defined as the composite of acute and chronic VTE or PVT. The impact of etiology of cirrhosis on the crude and risk adjusted rates of VTE and PVT was studied.
Results:
Of 432,383 patients with cirrhosis, 41.4% patients had NASH-cirrhosis, 39.7% had alcohol-related cirrhosis, and 18.9% had viral cirrhosis. The overall VTE rate was highest in patients with NASH cirrhosis (10.8%) followed by viral cirrhosis (9.7%) and alcohol-related cirrhosis (7.5%; P < 0.001). Similar results were observed for acute and chronic VTE. After risk adjustment, patients with NASH (OR 1.48 95% CI 1.42-1.54) and viral cirrhosis (OR 1.22 95% CI 1.17-1.29) had significantly higher overall VTE risk compared with alcohol-related cirrhosis. When separately evaluated, the adjusted risk for acute and chronic VTE was similar between patients with alcohol-related and viral cirrhosis but higher with NASH cirrhosis. PVT rate was highest with viral cirrhosis (4.3%) followed by NASH (2.8%) and alcohol-related cirrhosis (2.4%; P < 0.001). The adjusted risk of PVT was higher with viral (OR 1.61 95% CI 1.50-1.72) and NASH cirrhosis (OR 1.41 95% CI 1.31-1.52).
Conclusion:
NASH cirrhosis was associated with a higher VTE risk compared with alcohol-related and viral etiologies. As NASH cirrhosis increases in prevalence as the major etiology of cirrhosis, it is important to understand the increased VTE risk associated with this condition to improve management strategies and patient outcomes.
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