Liver cirrhosis is associated with venous thromboembolism among hospitalized patients in a nationwide US study

Background & Aims: Studies on the impact of liver disease on venous thromboembolism (VTE) have produced conflicting results. We assessed the risk of VTE in patients with compensated or decompensated cirrhosis. Methods: Data on hospital discharges of patients with liver cirrhosis and a random sample of control patients (without liver disease, 1%) were analyzed from the Nationwide Inpatient Sample (1998-2006). Prevalence of VTE was compared among patients with and without cirrhosis. The impact of VTE on in-hospital mortality and length of stay (LOS) was assessed. Results: After multivariate adjustment, patients with compensated and decompensated cirrhosis were at higher risk of VTE until the age of 45 years (odds ratio [OR], 1.23; 95% confidence interval [CI], 1.04-1.46 and OR, 1.39; 95% CI, 1.15-1.69, respectively). After 45 years of age, compensated cirrhosis was associated with a modest decrease in adjusted odds of VTE (OR, 0.90; 95% CI, 0.85-0.95) whereas decompensated cirrhosis was not associated with higher risk of VTE (OR, 0.97; 95% CI, 0.91-1.04). VTE was associated with increased mortality among patients with compensated cirrhosis (OR, 2.16; 95% CI, 1.96-2.38) or decompensated cirrhosis (OR, 1.66, 95% CI, 1.47-1.87). VTE was associated with a 103% increase in length of stay (95% CI, 95%-111% increase) among patients with compensated cirrhosis and an 86% increase (95% CI, 78%-94% increase) among those with decompensated cirrhosis. Conclusions: Patients with cirrhosis under the age of 45 years are at higher risk for VTE that those without liver disease and should be considered for VTE prophylaxis.