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Venous Thromboembolism in Patients with Liver Cirrhosis: Findings from the RIETE (Registro Informatizado de la Enfermedad TromboEmbolica) Registry.
Bikdeli, Behnood; Jiménez, David; Garcia-Tsao, Guadalupe; Barba, Raquel; Font, Carme; Díaz-Pedroche, María Del Carmen; Mazzolai, Lucia; Little, Derek Henry Wallace; Tufano, Antonella; Tafur, Alfonso J; Siegal, Deborah; Lip, Gregory Y H; Monreal, Manuel.
Afiliação
  • Bikdeli B; Division of Cardiology, Department of Medicine, NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, New York.
  • Jiménez D; Center for Outcomes Research & Evaluation, Yale School of Medicine, New Haven, Connecticut.
  • Garcia-Tsao G; Cardiovascular Research Foundation, New York, New York.
  • Barba R; Department of Respiratory, Hospital Ramón y Cajal, Madrid, Spain.
  • Font C; Department of Medicine, Universidad de Alcalá (IRYCIS), Madrid, Spain.
  • Díaz-Pedroche MDC; Section of Digestive Diseases, Department of Medicine, Yale School of Medicine, New Haven, Connecticut.
  • Mazzolai L; Department of Internal Medicine, Fundación Hospital Alcorcón, Madrid, Spain.
  • Little DHW; Department of Medical Oncology, Hospital Clínic, Barcelona, Spain.
  • Tufano A; Department of Internal Medicine, Hospital Universitario de Octubre, Madrid, Spain.
  • Tafur AJ; Department of Angiology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
  • Siegal D; Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
  • Lip GYH; Regional Reference Centre for Coagulation Disorders, Department of Clinical Medicine and Surgery, Federico II, University Hospital, Naples, Italy.
  • Monreal M; Department of Medicine, Vascular Medicine, NorthShore University HealthSystem, University of Chicago, Chicago, Illinois.
Semin Thromb Hemost ; 45(8): 793-801, 2019 Nov.
Article em En | MEDLINE | ID: mdl-31614388
Patients with cirrhosis are not only at an increased risk of bleeding but also at risk of venous thromboembolism (VTE). We sought to determine the clinical characteristics, management, and outcomes after VTE in patients with cirrhosis. We used the data from RIETE (Registro Informatizado de la Enfermedad TromboEmbolica), an international registry of patients with VTE, to compare the outcomes in patients with and without cirrhosis. Main outcomes included all-cause mortality, pulmonary embolism (PE)-related mortality, recurrent VTE, and bleeding. Among 43,611 patients with acute VTE, 187 (0.4%) had cirrhosis. Of these, 184 (98.4%) received anticoagulation for a median of 109 days (interquartile range [IQR]: 43-201 days), most commonly with enoxaparin (median dose: 1.77 [IQR: 1.38-2.00] mg/kg/day). Compared with patients without cirrhosis, those with cirrhosis had a higher rate of all-cause mortality (10.7 vs. 3.4%; odds ratio [OR]: 3.41; 95% confidence interval [CI]: 2.03-5.46) and fatal bleeding (2.1 vs. 0.2%; OR: 13.94; 95% CI: 3.65-37.90) but similar rates of fatal PE (0.5 vs. 0.5%; OR: 1.17; 95% CI: 0.03-6.70). Patients with cirrhosis had a higher rate of all-cause mortality per 100 patient-years of follow-up (58.9 vs. 16.0; hazard ratio [HR]: 3.70; 95% CI: 2.69-4.91). One-year hazard ratio of clinically relevant bleeding (HR: 2.86; 95% CI: 1.91-4.27), fatal bleeding (HR: 8.51; 95% CI: 3.5-20.7), or recurrent VTE (HR: 2.08; 95% CI: 1.00-4.36) was higher in patients with cirrhosis. Cirrhosis is a challenging comorbidity in patients with VTE. Most patients were treated with anticoagulation and had an elevated risk of recurrence, similar risk of fatal PE, and a very high risk of bleeding including fatal bleeds.
Assuntos

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Tromboembolia Venosa / Cirrose Hepática Tipo de estudo: Diagnostic_studies Limite: Aged / Female / Humans / Male Idioma: En Ano de publicação: 2019 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Tromboembolia Venosa / Cirrose Hepática Tipo de estudo: Diagnostic_studies Limite: Aged / Female / Humans / Male Idioma: En Ano de publicação: 2019 Tipo de documento: Article