Risk of Venous Thromboembolism in Patients with Chronic Liver Disease and the Utility of Venous Thromboembolism Prophylaxis

OBJECTIVE: To review the current literature on the risk of venous thromboembolism (VTE) in patients with chronic liver disease (CLD). DATA SOURCES: Literature was accessed through MEDLINE/PubMed (1996-December 2011) using the search terms liver disease, cirrhosis, venous thromboembolism, deep vein thrombosis, and pulmonary embolism. STUDY SELECTION AND DATA EXTRACTION: Relevant observational and population-based studies were included to present background information. Bibliographies of all relevant articles were reviewed for additional citations. DATA SYNTHESIS: Liver disease affects the synthesis of procoagulants and anticoagulants, resulting in hemostatic alterations and abnormal laboratory values. Retrospective studies characterized the VTE incidence to be 0.5-6.3%. Population-based studies reported VTE relative risks of 1.74-2.10 in patients with CLD compared with population controls and VTE odds ratios of 0.9-1.39 for hospitalized patients with CLD compared with controls without liver disease. There is a paucity of data on the use of pharmacologic prophylaxis in patients with CLD. CONCLUSIONS: Patients with CLD should be assessed for VTE risk and given VTE prophylaxis when the benefits outweigh the risks. Diagnoses of CLD or elevated international normalized ratio do not confer protection against development of VTE and do not justify withholding pharmacologic prophylaxis based on this diagnosis.