Liver status and outcomes in patients without previous known liver disease receiving anticoagulant therapy for venous thromboembolism

Abstract

The association between elevated liver enzymes or FIB-4 (fibrosis index 4) and outcome in patients with venous thromboembolism (VTE) has not been evaluated. Data from patients in RIETE (Registro Informatizado Enfermedad TromboEmbólica) were used to assess the association between elevated liver enzymes or FIB-4 levels and the rates of major bleeding or death in apparent liver disease-free patients with acute VTE under anticoagulation therapy. A total of 6206 patients with acute VTE and without liver disease were included. Of them, 92 patients had major bleeding and 168 died under anticoagulation therapy. On multivariable analysis, patients with elevated liver enzymes were at increased mortality risk (HR: 1.58; 95% CI: 1.10-2.28), while those with FIB-4 levels > 2.67 points were at increased risk for major bleeding (HR: 1.69; 95% CI: 1.04-2.74). Evaluation of liver enzymes and FIB-4 index at baseline in liver disease-free patients with VTE may provide additional information on the risk for major bleeding or death during anticoagulation.

Trial registration: ClinicalTrials.gov NCT02832245.

Keywords: Anticoagulation adverse events; Clinical VTE; Healthy individuals; Non-invasive liver assessment; VTE risk assessment.

Fig. 1

Flow chart of selection of patients for final analysis

Fig. 2

Adjusted Cox regression analysis for all-cause mortality during anticoagulation, according to elevated vs. normal liver enzymes

Fig. 3

Adjusted Cox regression analysis for major bleeding during anticoagulation according to risk for liver fibrosis