Risk and outcome of venous and arterial thrombosis in patients with cirrhosis: a Danish nationwide cohort study

Jepsen, Peter; Tapper, Elliot B.; Deleuran, Thomas; Kazankov, Konstantin; Askgaard, Gro; Toft Sørensen, Henrik; Vilstrup, Hendrik; West, Joe

Abstract

Background & Aims

Cirrhosis affects hemostasis, but its effects across the spectrum of thromboses remain poorly understood. We examined risks and outcomes of venous and arterial thrombosis.

Approach & Results

We used nationwide Danish healthcare registries to identify outpatients with cirrhosis and a sex- and age-matched comparison cohort without cirrhosis from the general population. Patients with cirrhosis and comparators were followed until they had a venous thromboembolism, acute myocardial infarction, ischemic stroke, or died. We computed absolute risks and hazard ratios of thrombosis, and compared outcomes after thrombosis. We included 5,854 patients with cirrhosis (median MELD score 9, IQR 7–13), and their risk of any of the thrombotic events was 0.8% after 1 year and 6.3% after 10 years. They were more likely than the 23,870 matched comparators to have venous thromboembolism (adjusted hazard ratio [HR] 2.0, 95% CI 1.5–2.6) or ischemic stroke (adjusted HR 1.7, 95% CI 1.3–2.3), but not myocardial infarction (adjusted HR 0.7, 95% CI 0.5–0.9). Among patients with cirrhosis, decompensation increased the risk of acute myocardial infarction but not the other thromboses. Following thrombosis, patients with cirrhosis had higher 90-day mortality than comparators (after venous thromboembolism: 17% vs. 7%; after acute myocardial infarction: 27% vs. 5%; after ischemic stroke: 10% vs. 7%) and were less likely to receive antithrombotic treatment.

Conclusions

Patients with cirrhosis had an increased risk of venous thromboembolism and ischemic stroke, but not acute myocardial infarction. Among patients with cirrhosis, decompensation increased the risk of myocardial infarction, exclusively. Mortality after thrombosis was higher in patients with cirrhosis than in other patients. These findings are relevant for decisions about antithrombotic prophylaxis in patients with cirrhosis.

• Journal Article Type: Article
• Acceptance Date: Jun 14, 2021
• Online Publication Date: Jun 16, 2021
• Publication Date: 2021-11
• Deposit Date: Jun 30, 2021
• Publicly Available Date: Jun 17, 2022
• Journal: Hepatology
• Print ISSN: 0270-9139
• Electronic ISSN: 1527-3350
• Peer Reviewed: Peer Reviewed
• Volume: 74
• Issue: 5
• Pages: 2725-2734
• DOI: https://doi.org/10.1002/hep.32019
• Public URL: https://nottingham-repository.worktribe.com/output/5748211
• Publisher URL: https://aasldpubs.onlinelibrary.wiley.com/doi/abs/10.1002/hep.32019
• Additional Information: This is the peer reviewed version of the following article: Jepsen, P., Tapper, E.B., Deleuran, T., Kazankov, K., Askgaard, G., Sørensen, H.T., Vilstrup, H. and West, J. (2021), Risk and outcome of venous and arterial thrombosis in patients with cirrhosis: a Danish nationwide cohort study. , which has been published in final form at https://aasldpubs.onlinelibrary.wiley.com/doi/abs/10.1002/hep.32019. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions