Increased risk of venous thromboembolism in hospitalized patients with cirrhosis due to non-alcoholic steatohepatitis original-contribution

Jonathan G. Stine, Blake A. Niccum, Alex N. Zimmet, Nicolas Intagliata, Stephen H. Caldwell, Curtis K. Argo, Patrick G. Northup

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Objective: Patients with cirrhosis are at increased risk for venous thromboembolism (VTE) and portal vein thrombosis (PVT). Cirrhosis due to non-alcoholic steatohepatitis (NASH) appears to be particularly prothrombotic. We investigated hospitalized patients with NASH cirrhosis to determine if they are at increased risk for VTE. Methods: Data on adult hospitalized patients with cirrhosis and VTE (deep vein thrombosis and/or pulmonary embolism) between November 1, 2010 and December 31, 2015 were obtained. Cases with VTE were matched by age, gender, and model for end stage liver disease (MELD) score to corresponding controls without VTE. Results: Two hundred and ninety subjects (145 matched pairs) with mean age of 58.4 ± 11.8 years and MELD score of 16.0 ± 7.2 were included. Baseline characteristics were similar between cases and controls. Independent adjusted risk factors for VTE included NASH (OR: 2.46, 95% CI: 1.07-5.65, p = 0.034), prior VTE (OR: 7.12, 95% CI: 1.99-25.5, p = 0.003), and presence of PVT (OR: 2.18, 95% CI: 1.03-4.58, p = 0.041). Thrombocytopenia was associated with decreased risk (OR: 0.49, 95% CI: 0.26-0.95, p = 0.035). Conclusions: NASH is an independent risk factor for VTE among cirrhosis patients and provides further evidence that NASH is a hypercoagulable state. While all hospitalized patients with cirrhosis at risk for VTE should be considered for medical thromboprophylaxis, those with NASH cirrhosis are at particularly increased risk and therefore a high index of suspicion for VTE should be maintained even in the presence of thromboprophylaxis.

Original languageEnglish (US)
Article number140
JournalClinical and Translational Gastroenterology
Volume9
Issue number3
DOIs
StatePublished - Mar 1 2018

Fingerprint

Venous Thromboembolism
Fatty Liver
Fibrosis
End Stage Liver Disease
Portal Vein
Thrombosis
Pulmonary Embolism
Venous Thrombosis
Thrombocytopenia

All Science Journal Classification (ASJC) codes

  • Gastroenterology

Cite this

Stine, Jonathan G. ; Niccum, Blake A. ; Zimmet, Alex N. ; Intagliata, Nicolas ; Caldwell, Stephen H. ; Argo, Curtis K. ; Northup, Patrick G. / Increased risk of venous thromboembolism in hospitalized patients with cirrhosis due to non-alcoholic steatohepatitis original-contribution. In: Clinical and Translational Gastroenterology. 2018 ; Vol. 9, No. 3.
@article{15ea4a4cd6df4c7a8509464d63bee23e,
title = "Increased risk of venous thromboembolism in hospitalized patients with cirrhosis due to non-alcoholic steatohepatitis original-contribution",
abstract = "Objective: Patients with cirrhosis are at increased risk for venous thromboembolism (VTE) and portal vein thrombosis (PVT). Cirrhosis due to non-alcoholic steatohepatitis (NASH) appears to be particularly prothrombotic. We investigated hospitalized patients with NASH cirrhosis to determine if they are at increased risk for VTE. Methods: Data on adult hospitalized patients with cirrhosis and VTE (deep vein thrombosis and/or pulmonary embolism) between November 1, 2010 and December 31, 2015 were obtained. Cases with VTE were matched by age, gender, and model for end stage liver disease (MELD) score to corresponding controls without VTE. Results: Two hundred and ninety subjects (145 matched pairs) with mean age of 58.4 ± 11.8 years and MELD score of 16.0 ± 7.2 were included. Baseline characteristics were similar between cases and controls. Independent adjusted risk factors for VTE included NASH (OR: 2.46, 95{\%} CI: 1.07-5.65, p = 0.034), prior VTE (OR: 7.12, 95{\%} CI: 1.99-25.5, p = 0.003), and presence of PVT (OR: 2.18, 95{\%} CI: 1.03-4.58, p = 0.041). Thrombocytopenia was associated with decreased risk (OR: 0.49, 95{\%} CI: 0.26-0.95, p = 0.035). Conclusions: NASH is an independent risk factor for VTE among cirrhosis patients and provides further evidence that NASH is a hypercoagulable state. While all hospitalized patients with cirrhosis at risk for VTE should be considered for medical thromboprophylaxis, those with NASH cirrhosis are at particularly increased risk and therefore a high index of suspicion for VTE should be maintained even in the presence of thromboprophylaxis.",
author = "Stine, {Jonathan G.} and Niccum, {Blake A.} and Zimmet, {Alex N.} and Nicolas Intagliata and Caldwell, {Stephen H.} and Argo, {Curtis K.} and Northup, {Patrick G.}",
year = "2018",
month = "3",
day = "1",
doi = "10.1038/s41424-018-0002-y",
language = "English (US)",
volume = "9",
journal = "Clinical and Translational Gastroenterology",
issn = "2155-384X",
publisher = "Nature Publishing Group",
number = "3",

}

Increased risk of venous thromboembolism in hospitalized patients with cirrhosis due to non-alcoholic steatohepatitis original-contribution. / Stine, Jonathan G.; Niccum, Blake A.; Zimmet, Alex N.; Intagliata, Nicolas; Caldwell, Stephen H.; Argo, Curtis K.; Northup, Patrick G.

In: Clinical and Translational Gastroenterology, Vol. 9, No. 3, 140, 01.03.2018.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Increased risk of venous thromboembolism in hospitalized patients with cirrhosis due to non-alcoholic steatohepatitis original-contribution

AU - Stine, Jonathan G.

AU - Niccum, Blake A.

AU - Zimmet, Alex N.

AU - Intagliata, Nicolas

AU - Caldwell, Stephen H.

AU - Argo, Curtis K.

AU - Northup, Patrick G.

PY - 2018/3/1

Y1 - 2018/3/1

N2 - Objective: Patients with cirrhosis are at increased risk for venous thromboembolism (VTE) and portal vein thrombosis (PVT). Cirrhosis due to non-alcoholic steatohepatitis (NASH) appears to be particularly prothrombotic. We investigated hospitalized patients with NASH cirrhosis to determine if they are at increased risk for VTE. Methods: Data on adult hospitalized patients with cirrhosis and VTE (deep vein thrombosis and/or pulmonary embolism) between November 1, 2010 and December 31, 2015 were obtained. Cases with VTE were matched by age, gender, and model for end stage liver disease (MELD) score to corresponding controls without VTE. Results: Two hundred and ninety subjects (145 matched pairs) with mean age of 58.4 ± 11.8 years and MELD score of 16.0 ± 7.2 were included. Baseline characteristics were similar between cases and controls. Independent adjusted risk factors for VTE included NASH (OR: 2.46, 95% CI: 1.07-5.65, p = 0.034), prior VTE (OR: 7.12, 95% CI: 1.99-25.5, p = 0.003), and presence of PVT (OR: 2.18, 95% CI: 1.03-4.58, p = 0.041). Thrombocytopenia was associated with decreased risk (OR: 0.49, 95% CI: 0.26-0.95, p = 0.035). Conclusions: NASH is an independent risk factor for VTE among cirrhosis patients and provides further evidence that NASH is a hypercoagulable state. While all hospitalized patients with cirrhosis at risk for VTE should be considered for medical thromboprophylaxis, those with NASH cirrhosis are at particularly increased risk and therefore a high index of suspicion for VTE should be maintained even in the presence of thromboprophylaxis.

AB - Objective: Patients with cirrhosis are at increased risk for venous thromboembolism (VTE) and portal vein thrombosis (PVT). Cirrhosis due to non-alcoholic steatohepatitis (NASH) appears to be particularly prothrombotic. We investigated hospitalized patients with NASH cirrhosis to determine if they are at increased risk for VTE. Methods: Data on adult hospitalized patients with cirrhosis and VTE (deep vein thrombosis and/or pulmonary embolism) between November 1, 2010 and December 31, 2015 were obtained. Cases with VTE were matched by age, gender, and model for end stage liver disease (MELD) score to corresponding controls without VTE. Results: Two hundred and ninety subjects (145 matched pairs) with mean age of 58.4 ± 11.8 years and MELD score of 16.0 ± 7.2 were included. Baseline characteristics were similar between cases and controls. Independent adjusted risk factors for VTE included NASH (OR: 2.46, 95% CI: 1.07-5.65, p = 0.034), prior VTE (OR: 7.12, 95% CI: 1.99-25.5, p = 0.003), and presence of PVT (OR: 2.18, 95% CI: 1.03-4.58, p = 0.041). Thrombocytopenia was associated with decreased risk (OR: 0.49, 95% CI: 0.26-0.95, p = 0.035). Conclusions: NASH is an independent risk factor for VTE among cirrhosis patients and provides further evidence that NASH is a hypercoagulable state. While all hospitalized patients with cirrhosis at risk for VTE should be considered for medical thromboprophylaxis, those with NASH cirrhosis are at particularly increased risk and therefore a high index of suspicion for VTE should be maintained even in the presence of thromboprophylaxis.

UR - http://www.scopus.com/inward/record.url?scp=85042931321&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85042931321&partnerID=8YFLogxK

U2 - 10.1038/s41424-018-0002-y

DO - 10.1038/s41424-018-0002-y

M3 - Article

C2 - 29511162

AN - SCOPUS:85042931321

VL - 9

JO - Clinical and Translational Gastroenterology

JF - Clinical and Translational Gastroenterology

SN - 2155-384X

IS - 3

M1 - 140

ER -