Prevalence of thrombosis in patients with chronic liver disease presenting to a tertiary care health facility of Sindh
DOI:
https://doi.org/10.55629/pakjpathol.v37i3.1040Abstract
Objective: To identify the prevalence of thrombosis in Chronic liver disease (CLD) patients visiting a tertiary care hospital in Sindh.
Material and Methods: The study was a prospective cross-sectional descriptive study done in the Department of Internal Medicine, Jinnah Postgraduate Medical Centre (JPMC), Karachi, within six months. Consecutive sampling was applied in the enrollment of 164 patients aged between 18 and 70 years old with CLD. Demographic data, comorbidities, and the duration of the disease was reported. Clinical assessment was done to determine thrombosis and was verified by Doppler ultrasound. The analysis of the data was done with SPSS version 24. Risk factors were evaluated with the help of logistic regression.
Results: The mean age of participants was 49.8 (12.6) years, and 102 (62.2%) patients were male. Hepatitis C infection was the most frequent etiology (92 [56.1%]), followed by hepatitis B infection (47 [28.7%]). Thrombosis was diagnosed in 18 (11.0%) patients, with deep vein thrombosis (DVT) being the predominant type (77.8%). Significant associations were observed with age >50 years (p=0.030), diabetes mellitus (p=0.041), and CLD duration >5 years (p=0.021).
Conclusion: Thrombosis is a common issue in CLD patients, which should be subject to clinical attention. This high-risks group may have morbidity reduced by selective thromboprophylaxis.
Keywords: Cirrhosis, Chronic liver disease, Doppler ultrasound, Thrombosis, Venous thromboembolism.
References
European Association for the Study of the Liver. EASL clinical practice guidelines on the management of decompensated cirrhosis. J Hepatol. 2022; 77(3): 807-24. DOI: https://doi.org/10.1016/j.jhep.2022.06.002
Simonetto DA, Singal AK, Garcia-Tsao G, Caldwell SH, Ahn J, Kamath PS. ACG Clinical Guideline: Disorders of the hepatic and mesenteric circulation. Am J Gastroenterol. 2022; 115(1): 18-40. DOI: https://doi.org/10.14309/ajg.0000000000000486
Northup PG, Garcia-Pagán JC, Garcia-Tsao G, Intagliata NM, Superina RA, Roberts LN, et al. Vascular liver disorders, portal vein thrombosis, and procedural bleeding in patients with liver disease: Updated guidance. Hepatology. 2021; 73(1): 366-413. DOI: https://doi.org/10.1002/hep.31646
Lim JK. Diagnosis and management of portal vein thrombosis in patients with cirrhosis. Gastroenterol Hepatol (NY). 2025; 21(11): 711-4. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC12853760/pdf/GH-21-11-711.pdf
Qi X, Han G, Fan D. Management of portal vein thrombosis in cirrhosis. Nat Rev Gastroenterol Hepatol. 2014; 11: 434-46. DOI: https://doi.org/10.1038/nrgastro.2014.36
Tapper EB, Parikh ND. Diagnosis and management of cirrhosis and its complications: current evidence and future directions. JAMA. 2024; 329(18): 1589-1602. DOI: https://doi.org/10.1001/jama.2023.5997
Ginès P, Krag A, Abraldes JG, Solà E, Fabrellas N, Kamath PS. Liver cirrhosis. Lancet. 2023; 401 (10383): 1577-90.
DOI: https://doi.org/10.1016/s0140-6736(22) 02459-x
Moon AM, Singal AG, Tapper EB. Contemporary epidemiology of chronic liver disease and cirrhosis. Clin Gastroenterol Hepatol. 2020; 18(12): 2650-66. DOI: https://doi.org/10.1016/j.cgh.2022.03.044
Faccia M, Santopaolo F, Gasbarrini A, Pompili M, Zocco MA, Ponziani FR. Risk factors for portal vein thrombosis or venous thromboembolism in a large cohort of hospitalized cirrhotic patients. Intern Emerg Med. 2022; 17(5): 1327-34. DOI: https://doi.org/10.1007/s11739-022-02928-8
da Cruz Renó L, Tustumi F, Waisberg DR, Rocha-Santos V, Pinheiro RS, Macedo RA, et al. Venous thromboembolism in in-hospital cirrhotic patients: A systematic review. Front Med (Lausanne). 2022; 9: 1027882.
DOI: https://doi.org/10.3389/fmed.2022.1027882
Lisman T, Hernandez-Gea V, Magnusson M, Roberts L, Stanworth S, Thachil J, et al. The concept of rebalanced hemostasis in patients with liver disease: communication from the ISTH SSC working group on hemostatic management of patients with liver disease. J Thromb Haemost. 2021; 19(4): 1116-22. DOI: https://doi.org/10.1111/jth.15239
Li J, Wang Q, Yang M, Sun X. Metabolic disorders and risk of portal vein thrombosis in liver cirrhosis: A systematic review and meta-analysis. Turk J Gastroenterol. 2022; 33(7): 541-53. DOI: https://doi.org/10.5152/tjg.2022.211022
Lisman T, Caldwell SH, Intagliata NM. Haemostatic alterations and management of haemostasis in patients with cirrhosis. J Hepatol. 2022; 76(6): 1291-305.
DOI: https://doi.org/10.1016/j.jhep.2021.11.004
Turon F, Driever EG, Baiges A, Cerda E, García-Criado Á, Gilabert R, et al. Predicting portal thrombosis in cirrhosis: A prospective study of clinical, ultrasonographic and hemostatic factors. J Hepatol. 2021; 75(6): 1367-76.
DOI: https://doi.org/10.1016/j.jhep.2021.07.020
Roberts LN. Rebalanced hemostasis in liver disease: A misunderstood coagulopathy. Hematology Am Soc Hematol Educ Program. 2021; 2021(1): 485-91.
DOI:https://doi.org/10.1182/hematology.2021000283
European Association for the Study of the Liver. EASL Clinical Practice Guidelines on non-invasive tests for evaluation of liver disease severity and prognosis - 2021 update. J Hepatol. 2021; 75(3): 659-89.
DOI: https://doi.org/10.1016/j.jhep.2021.05.025
Davis JPE, Lim JK, Francis FF, Ahn J. AGA clinical practice update on management of portal vein thrombosis in patients with cirrhosis: Expert review. Gastroenterology. 2025; 168(2): 396-404.e1. DOI: https://doi.org/10.1053/j.gastro.2024.10.038
de Franchis R, Bosch J, Garcia-Tsao G, Reiberger T, Ripoll C. Baveno VII Faculty. Baveno VII—Renewing consensus in portal hypertension. J Hepatol. 2022; 76(4): 959-974. DOI: https://doi.org/10.1016/j.jhep.2021.12.022
Abou Yassine A, Abureesh M, Hamadi R, Dahabra L, Alshami M, Liliane D. Predictors of deep venous thrombosis in hospitalized patients with liver cirrhosis in the US. Cureus. 2022; 14(3): e23450. DOI: https://doi.org/10.7759/cureus.23450 .
Alsheikh M, Kamar K, Kreidieh M, Sasso R, Madala S, Sharma R, et al. The incidence of venous thromboembolism and practice of deep venous thrombosis prophylaxis among hospitalized cirrhotic patients. Gastroenterol Res. 2022; 15(2): 67-74. DOI: https://doi.org/10.14740/gr1493
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