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Risk Factors for Non-variceal Hemorrhage in Patients with Chronic Liver Disease

P. Kesavan1, A. Afzal1, S. Luo1,2, B. Gage1, M. Schoen2, K. Sanfilippo1,2

1Washington University School of Medicine, St. Louis, United States, 2St. Louis Veterans Health Administration Medical Center, St. Louis, United States

Abstract Number: PB0104

Meeting: ISTH 2021 Congress

Theme: Coagulation and Natural Anticoagulants » Hemostasis and Organ Dysfunction

Background: Patients with chronic liver disease (CLD) frequently experience non-variceal hemorrhage, which results in considerable morbidity, mortality, and healthcare costs. Available literature focuses on the prevention of variceal hemorrhage; however, studies identifying risk factors for non-variceal hemorrhage have been limited.

Aims: We assessed the role of various clinical and laboratory parameters in predicting the risk of non-variceal hemorrhage among CLD patients.

Methods: This is a large, retrospective cohort study of U.S. veterans diagnosed with CLD between October 1, 2002 and September 30, 2016. We excluded patients with a history of malignancy, artificial heart valves, atrial fibrillation, prior venous thromboembolism, and anticoagulation. We selected candidate predictors from the HEMORR2HAGES, HAS-BLED, and Child-Pugh risk prediction models. When appropriate, variables were analyzed as time-varying. We used competing risk analysis by methods of Fine and Grey to identify predictors of non-variceal hemorrhage within one year of CLD diagnosis.

Results: A total of 14,281 CLD patients were included in the study, and 576 hemorrhagic events were identified within one year of follow-up (Table 1). Most of the events occurred in the upper gastrointestinal (GI) tract (381), followed by lower GI tract (104), intracranial (35), and nasal/respiratory (31) hemorrhages. In competing risk analysis (Table 2), the following predictors were independently associated with non-variceal hemorrhage: elevated INR between 1.5 and 3, aspirin use, high bilirubin, low albumin, low glomerular filtration rate, prior hemorrhage, anemia, alcohol abuse, hemi- or paraplegia, and dementia.
Demographic and Clinical Characteristics Comparison for CLD Patients Diagnosed from 2002 to 2016Multivariate Analysis of Risk Factors for Non-Variceal Hemorrhage

Conclusions: Our study of over 14,000 veterans shows that severity of liver disease at presentation, aspirin use, concurrent renal failure, alcohol abuse, prior hemorrhage, and compromised self-care by either dementia or paraplegia predict a higher risk of hemorrhage within the first year after CLD diagnosis. This study was supported by the American Society of Hematology.

To cite this abstract in AMA style:

Kesavan P, Afzal A, Luo S, Gage B, Schoen M, Sanfilippo K. Risk Factors for Non-variceal Hemorrhage in Patients with Chronic Liver Disease [abstract]. Res Pract Thromb Haemost. 2021; 5 (Suppl 2). https://abstracts.isth.org/abstract/risk-factors-for-non-variceal-hemorrhage-in-patients-with-chronic-liver-disease/. Accessed December 11, 2023.

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