Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark.
Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.
Hepatology. 2021 Nov;74(5):2725-2734. doi: 10.1002/hep.32019. Epub 2021 Sep 9.
BACKGROUND AND AIMS: Cirrhosis affects hemostasis, but its effects across the spectrum of thromboses remain poorly understood. We examined risks and outcomes of venous and arterial thrombosis. APPROACH AND RESULTS: We used nation-wide Danish health care registries to identify outpatients with cirrhosis and a sex- and age-matched comparison cohort without cirrhosis from the general population. Patients with cirrhosis and comparators were followed until they had a venous thromboembolism (VTE), acute myocardial infarction (AMI), or ischemic stroke (IS) or died. We computed absolute risks and HRs of thrombosis and compared outcomes after thrombosis. We included 5,854 patients with cirrhosis (median Model for End-Stage Liver Disease score, 9; interquartile range, 7-13), and their risk of any of the thrombotic events was 0.8% after 1 year and 6.3% after 10 years. They were more likely than the 23,870 matched comparators to have a VTE (adjusted hazard ratio [aHR], 2.0; 95% CI, 1.5-2.6) or IS (aHR, 1.7; 95% CI, 1.3-2.3), but not AMI (aHR, 0.7; 95% CI, 0.5-0.9). Among patients with cirrhosis, decompensation increased the risk of AMI, but not the other thromboses. Following thrombosis, patients with cirrhosis had higher 90-day mortality than comparators (after VTE: 17% vs. 7%; after AMI: 27% vs. 5%; after IS: 10% vs. 7%) and were less likely to receive antithrombotic treatment. CONCLUSIONS: Patients with cirrhosis had an increased risk of VTE and IS, but not AMI. Among patients with cirrhosis, decompensation increased the risk of AMI, exclusively. Mortality after thrombosis was higher in patients with cirrhosis than in other patients. These findings are relevant for decisions about antithrombotic prophylaxis in patients with cirrhosis.
背景与目的:肝硬化会影响止血功能,但人们对其在各种血栓形成中的影响知之甚少。本研究旨在探讨静脉和动脉血栓形成的风险和结局。
方法和结果:我们利用丹麦全国性的医疗保健登记系统,确定了肝硬化门诊患者,并从一般人群中选取了年龄和性别相匹配的无肝硬化对照队列。肝硬化患者和对照组患者随访至发生静脉血栓栓塞症(VTE)、急性心肌梗死(AMI)或缺血性卒中(IS)或死亡。我们计算了血栓形成的绝对风险和 HR,并比较了血栓形成后的结局。我们纳入了 5854 名肝硬化患者(中位终末期肝病模型评分 9 分,四分位间距 7-13),随访 1 年时他们任何一种血栓事件的风险为 0.8%,10 年时为 6.3%。与 23870 名匹配的对照组相比,他们更有可能发生 VTE(调整后的危险比 [aHR],2.0;95%可信区间 [CI],1.5-2.6)或 IS(aHR,1.7;95%CI,1.3-2.3),但不太可能发生 AMI(aHR,0.7;95%CI,0.5-0.9)。在肝硬化患者中,肝功能失代偿增加了 AMI 的风险,但不增加其他血栓形成的风险。发生血栓形成后,与对照组相比,肝硬化患者的 90 天死亡率更高(VTE 后:17% vs. 7%;AMI 后:27% vs. 5%;IS 后:10% vs. 7%),且接受抗血栓治疗的可能性更低。
结论:肝硬化患者发生 VTE 和 IS 的风险增加,但发生 AMI 的风险不增加。在肝硬化患者中,肝功能失代偿仅增加 AMI 的风险。与其他患者相比,发生血栓形成后的肝硬化患者死亡率更高。这些发现与肝硬化患者抗血栓预防决策相关。
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