Incidence and prevalence of venous thromboembolism in chronic liver disease: A systematic review and meta-analysis

Subhani, Mohsan; Sheth, Abhishek; Ahmed, Jamal; Wijayasiri, Pramudi; Gardezi, Syed A.; Enki, Doyo; Morling, Joanne R.; Aithal, Guruprasad P.; Ryder, Stephen D.; Aravinthan, Aloysious D.

Abstract

Background and Aims: Historically, bleeding was thought to be a frequent and fatal complication of liver disease. However, thrombosis due to coagulation disorders in cirrhosis remains a real risk. We aim to systematically analyse published articles to evaluate epidemiology of venous thromboembolism (VTE) in chronic liver disease (CLD).

Method: Electronic search was conducted on Ovid Medline, EMBASE and Scopus from inception to November 2021 to identify studies presenting epidemiology VTE (deep vein thrombosis and pulmonary embolism) in CLD in inpatients and/or community settings. Random-effects meta-analysis was performed to determine pooled per-year cumulative incidence, incidence rate and prevalence. Heterogeneity was measured by I² test, and, potential sources of heterogeneity by meta-regression and sensitivity analysis. PROSPERO registration-CRD42021239117.

Results: Twenty-nine studies comprising 19,157,018 participants were included, of which 15,2049 (0.79%) had VTE. None of included the studies were done in the community. In hospitalised patients with CLD: pooled cumulative incidence of VTE was 1.07% (95%CI 0.80,1.38) per-year, incidence rate was 157.15 (95%CI 14.74,445.29) per 10,000 person-years, and period prevalence was 1.10% (95%CI 0.85,1.38) per year. There was significant heterogeneity and publication bias. Pooled relative risk (RR) of studies reporting incidence rate was 2.11 (95%CI 1.35,3.31). CLD patients (n=1644), who did not receive pharmacological prophylaxis were at 2.78 times (95% CI 1.11, 6.98) increased risk of VTE compared to those receiving prophylaxis.

Conclusion: Hospitalised patients with CLD may be at an increased risk of VTE . For every 1000 hospitalised patients with CLD ten have new, and eleven have pre-existing diagnoses of VTE per-year.

Citation

Subhani, M., Sheth, A., Ahmed, J., Wijayasiri, P., Gardezi, S. A., Enki, D., Morling, J. R., Aithal, G. P., Ryder, S. D., & Aravinthan, A. D. (2022). Incidence and prevalence of venous thromboembolism in chronic liver disease: A systematic review and meta-analysis. Thrombosis Research, 215, 19-29. https://doi.org/10.1016/j.thromres.2022.05.004

• Journal Article Type: Article
• Acceptance Date: May 7, 2022
• Online Publication Date: May 17, 2022
• Publication Date: Jul 1, 2022
• Deposit Date: May 17, 2022
• Publicly Available Date: May 18, 2023
• Journal: Thrombosis Research
• Print ISSN: 0049-3848
• Electronic ISSN: 1879-2472
• Publisher: Elsevier
• Peer Reviewed: Peer Reviewed
• Volume: 215
• Pages: 19-29
• DOI: https://doi.org/10.1016/j.thromres.2022.05.004
• Keywords: Chronic liver disease, Venous thromboembolism, Deep Vein Thrombosis, Pulmonary Embolism, Epidemiology, Incidence, Prevalence, Systematic review.
• Public URL: https://nottingham-repository.worktribe.com/output/8131866
• Publisher URL: https://www.sciencedirect.com/science/article/pii/S0049384822002572
• Additional Information: This article is maintained by: Elsevier; Article Title: Incidence and prevalence of venous thromboembolism in chronic liver disease: A systematic review and meta-analysis; Journal Title: Thrombosis Research; CrossRef DOI link to publisher maintained version: https://doi.org/10.1016/j.thromres.2022.05.004; Content Type: article; Copyright: © 2022 The Authors. Published by Elsevier Ltd.