Assessing clinical outcomes in cirrhotic patients with thromboembolic complications

Cirrhosis produces a rebalanced hemostatic state that predisposes patients to bleeding and thrombosis. We evaluated hepatic outcomes associated with deep vein thrombosis (DVT), pulmonary embolism, and portal vein thrombosis (PVT) in patients with cirrhosis.

We conducted a retrospective cohort study using the Nationwide Readmissions Database from 2016 to 2022. Adults with cirrhosis identified during January index hospitalizations were followed through the end of the same calendar year and classified as having no thromboembolism, DVT, pulmonary embolism, or PVT. The primary outcome was liver transplantation. Secondary outcomes included in-hospital mortality, ascites, esophageal or gastric varices, variceal hemorrhage, acute liver failure, and hepatic decompensation. Survey-weighted logistic regression estimated adjusted odds ratios (aORs).

The weighted cohort included 365 467 patients: 363 007 without thromboembolism, 730 with DVT, 1036 with pulmonary embolism, and 694 with PVT. DVT was associated with lower odds of liver transplantation [aOR, 0.19; 95% confidence interval (CI), 0.05-0.83] and mortality (aOR, 0.54; 95% CI, 0.37-0.77). Pulmonary embolism was associated with lower odds of varices, ascites, acute liver failure, and hepatic decompensation. PVT was associated with higher odds of varices (aOR, 2.47; 95% CI, 1.95-3.13) and variceal hemorrhage (aOR, 2.83; 95% CI, 1.59-5.02).

Thrombotic phenotypes in cirrhosis have distinct prognostic associations. PVT was associated with portal hypertensive complications, whereas apparently favorable associations with DVT and pulmonary embolism should be interpreted cautiously.