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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.

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


Clinical Assistant Professor(Clinical Lecturer in Gastroenterology)

Abhishek Sheth

Jamal Ahmed

Pramudi Wijayasiri

Syed A. Gardezi

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Senior Quantitative Methods Adviser and Researcher

Clinical Associate Professor

Stephen D. Ryder


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.

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 BV
Peer Reviewed Peer Reviewed
Volume 215
Pages 19-29
Keywords Chronic liver disease, Venous thromboembolism, Deep Vein Thrombosis, Pulmonary Embolism, Epidemiology, Incidence, Prevalence, Systematic review.
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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:; Content Type: article; Copyright: © 2022 The Authors. Published by Elsevier Ltd.


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