P95 Incidence and prevalence of venous thromboembolism in chronic liver disease: systematic review and meta-analysis

Abstract

<h3>Background and aims</h3> Historically, bleeding was thought to be a frequent and fatal complication of liver disease, thrombosis due to coagulation disorders in cirrhosis remains a real risk. We aim to systematically analyse published articles to evaluate the epidemiology of venous thromboembolism (VTE) in hospitalised patients with chronic liver disease. <h3>Method</h3> Electronic search was conducted on Ovid Medline, EMBASE and Scopus from databases inception to 2^nd November 2021. Random effects meta-analysis was performed to determine pooled per-year cumulative incidence, period prevalence, and incidence rate of VTE. Heterogeneity was measured by I² test, and, potential sources of heterogeneity by meta-regression and sub-group analysis. Joanna Briggs Institute’s methodological, and MOOSE reporting guidelines were followed. PROSPERO registration-CRD42021239117. <h3>Results</h3> Twenty-nine studies comprising 19,157,018 participants were included, of which 15,2049 (0.79%) had VTE. In hospitalised patients with chronic liver disease (CLD): pooled cumulative incidence of VTE was 1.07% (95%CI 0.80,1.38) per-year, incidence rate was 157.15 (95%CI 14.74,445.29) per 10,000 person-years, and period prevalence was 1.10% (95%CI 0.85,1.38) per-year. There was significant heterogeneity (I²99%,I²100%), and publication bias (p&lt;0.0001,p&lt;=0.04) (figure 1). Hospitalised patients with CLD had a pooled relative risk (RR) of 1.55 (95% CI 0.98, 2.45) for VTE compared to those without CLD. Pooled RR in studies reporting incidence rate was 2.11 (95%CI 1.35,3.31). In two studies (n=1644), patients with CLD who did not receive pharmacological prophylaxis were at significant increased risk of VTE compared to those receiving prophylaxis (RR 2.78, 95% CI 1.11, 6.98). <h3>Conclusion</h3> Hospitalised patients with chronic liver disease may be at an increased risk of VTE . For every 1000 hospitalised patients with chronic liver disease ten have new, and eleven have pre-existing diagnoses of venous thromboembolism per year.