Deep vein thrombosis and pulmonary embolism in cirrhotic patients: Systematic review

Abstract

Patients with liver cirrhosis were traditionally believed to be protected against development of blood clots. Lately, studies have shown that these patients may probably be at an increased risk of venous thrombotic complications. Although the hemostatic changes in the chronic liver disease patients and the factors that may predict bleeding vs thrombotic complications remains an area of active research, it is believed that the coagulation cascade is delicately balanced in these patients because of parallel reduced hepatic synthesis of pro and anticoagulant factors. Thrombotic state in cirrhotic patients is responsible for not only portal or non-portal thrombosis [deep vein thrombosis (DVT) and pulmonary embolism (PE)]; it has also been associated with progression of liver fibrosis. The use of anticoagulants in cirrhosis patients is a challenging, and often a scary situation. This review summarizes the current literature on the prevalence of venous thrombosis (DVT and PE), risk factors and safety of prophylactic and therapeutic anticoagulation in patients with chronic liver disease.

Keywords: Deep venous thrombosis; Chronic liver disease; Cirrhosis; Thrombosis; Anticoagulation; Pathogenesis; Portal vein thrombosis

Core tip: In this review, the current literature on the risk of venous thromboembolism (VTE) in cirrhosis patients is updated. There is no doubt that these patients are at risk for both venous thrombosis and bleeding, often presenting a challenge to the providers. VTE prophylaxis should be considered in all hospitalized cirrhotic patients, unless absolutely contraindicated. While the risk of bleeding from therapeutic anticoagulation cannot be excluded, a case of careful anticoagulation for treatment of VTE event should be made in the hands of experts.