Venous Thrombosis in Patients with Chronic Liver Disease

Patients with chronic liver disease are susceptible to bleeding and thrombotic complications of their disease, but the incidence of thrombosis and what predisposes them to thrombotic disease is largely unknown. One hundred and eight patients with chronic liver disease admitted with a first episode of venous thromboembolism, matched with patients of similar age, sex, and cause of liver disease without thrombosis were compared in a retrospective, case-control study over a 4-year period at two academic hospitals in Rhode Island. Incidence was determined from all admissions of patients with chronic liver disease during the specified time. Minimum and maximum values of complete blood counts, liver and kidney function tests, and coagulation tests during admission were compared between cases and controls. Incidence of new venous thrombosis in patients admitted with chronic liver disease was 0.73%. Patients with thromboses were more likely to have a lower albumin (2.77 vs. 3.49; P < 0.01) and hematocrit (37.7 vs. 40.2; P < 0.01) and higher platelet counts (143 vs. 109; P = 0.03), bilirubin (1.71 vs. 1.11; P < 0.01) and activated partial thromboplastin time (87 vs. 60.3; P < 0.01) as compared with controls. Although the incidence of thrombosis in patients with chronic liver disease is lower than the general medical population, hypoalbuminemia, anemia, and hyperbilirubinemia may confer increased risk of thrombosis whereas thrombocytopenia may be protective. Elevation of traditional markers of coagulation such as the prothrombin time and partial thromboplastin time does not safeguard against thrombotic events.