Venous Thromboembolism And Cerebral Infarction In Liver Cirrhosis

?Backgrounds?Traditionally,liver cirrhosis has a bleeding tendency,however,several recent studies have demonstrated that liver cirrhosis is associated with hypercoagulability,leading to the risk of venous thromboembolism(VTE)which is defined as deep vein thrombosis(DVT)and pulmonary embolism(PE).Risk factors include smoking,recent surgery,fracture,active cancer,inflammatory bowel disease,varicose veins,metabolic syndrome,obesity,oral glucocorticoids and contraceptives.Meanwhile,the effect of prophylaxis and treatment of anticoagulants in cirrhotic patients remain unclear.There is also no consensus about the epidemiology and risk factors of cerebral infarction,which has been the third commonest cause of mortality in more developed countries,in cirrhotic patients expect for advanced age,hypertension and hyperlipemia.?Objective?1.To explore the incidence,prevalence,risk factors,and in-hospital mortality of VTE in Chinese patients with liver cirrhosis.2.To compare the clinical characteristics and in-hospital outcomes between VTE patients with and without cirrhosis.3.To explore the epidemiology,risk factors,and influences of cerebral infarction in cirrhotic patients.?Methods?1.All patients with liver cirrhosis who were consecutively admitted to our hospital between January 2011 and December 2013 were retrospectively included.2.All patients with VTE consecutively admitted to our hospital between January 2011 and December 2015 were retrospectively collected.Case and control group were defined as VTE with and without cirrhosis,respectively.Matching factors were the age,sex,and Charlson Comorbidity Index score.3.All patients with liver cirrhosis consecutively admitted to our hospital between January 2011 and June 2014 were retrospectively reviewed.?Results?1.Of 2006 patients with liver cirrhosis included,9 patients were diagnosed with or developed VTE during hospitalization,including 5 patients with a previous history of DVT,one patient with both a previous history of DVT and new onset of PE,one patient with new onset of PE and 2 patients with new onset of DVT.Risk factors for VTE included a significantly higher proportion of hypertension and significantly higher red blood cell,hemoglobin,alanine aminotransferase,aspartate aminotransferase,prothrombin time,international normalized ratio,D-dimer,and Child-Pugh scores.The in-hospital mortality was significantly higher in patients with VTE than those without VTE(33.3% [3/9] vs 3.4% [67/1997],P<0.001).2.Sixteen and 160 patients were included in the case and control groups,respectively.The case group had higher Child-Pugh score,prothrombin time,and international normalized ratio and lower red blood cell,platelet,and albumin that the control group.The frequency of anticoagulant therapies was significantly lower in the case group than the control group(50% [8/16] vs 90.6% [145/160],P<0.001).The incidence of major bleeding and in-hospital mortality were significantly higher in the case group than the control group(43.8% [7/16] vs 13.8% [22/160],P=0.006;37.5% [6/16] vs 7.5% [12/160],P=0.002).In the case group,the incidence of major bleeding and in-hospital mortality were not significantly different between patients who received and did not receive anticoagulants(25% [2/8] vs 62.5% [5/8],P=0.315;25% [2/8] vs 50% [4/8],P=0.608).3.Of 2444 patients with liver cirrhosis included,160 patients were diagnosed with cerebral infarction,including 128 patients with a previous history of cerebral infarction and 32 patients with new onset of cerebral infarction during their hospitalizations.Compared to cirrhotic patients without cerebral infarction,those with cerebral infarction were significantly older and had a significantly higher proportion of arterial hypertension,significantly higher white blood cell,platelet,blood urea nitrogen,and triglyceride,and significantly lower hepatitis B virus,alanine aminotransferase,aspartate aminotransferase,and prothrombin time.The in-hospital mortality was significantly higher in patients with cerebral infarction than those without(8.80%,[14/160] vs 3.2%,[72/2284],P=0.001).?Conclusions?1.VTE was observed in 0.4% of patients with liver cirrhosis during hospitalization and significantly increased the in-hospital mortality.An elevated prothrombin time or international normalized ratio aggravated the risk of VTE.2.Cirrhosis may increase the risk of major bleeding and in-hospital death in patients with VTE.Anticoagulant therapies may not influence the risk of major bleeding and in-hospital death in cirrhosis with VTE.3.Incidence and prevalence of cerebral infarction in liver cirrhosis were 1.31% and 6.55%,respectively.Risk factors included advanced age,hypertriglyceridemia,hypertension and higher C-reactive protein,white blood cell and blood urea nitrogen.Higher hepatitis B virus and prothrombin time and lower platelet may protect cirrhotic patients from cerebral infarction.Cerebral infarction significantly increased the in-hospital mortality of patients with cirrhosis.