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 pa...