Pulmonary embolism and deep venous thrombosis in hospitalized patients with liver cirrhosis

摘要

Bleeding complications are common in patients with liver cirrhosis and are frequently thought to be "auto-anticoagulated"; as such, they present little or no risk of venous thrombotic events (VTE) including pulmonary embolism and deep venous thrombosis. However, the true incidence of thromboembolism in liver cirrhosis patients is difficult to ascertain because of the paucity of data.Here, we present liver cirrhosis patients who suffered critical VTE and describe the incidence of cirrhotic VTE at our institute. A 63-year-old woman with a history of alcoholism and cirrhosis (Child-Pugh class B) was admitted for a right ankle fracture that required surgical repair. Before her operation, two 5-mg doses of vitamin K were given orally to reverse the hypocoagulability (prothrombin time [PT], 21.1s and international normalized ratio [INR], 2.4). On the second hospital day, while in the preoperative evaluation unit, the patient had a sudden onset of shortness of breath and went into cardiopulmonary arrest. After the patient was resuscitated, pulmonary embolism was diagnosed in both lungs using spiral computed tomography. An inferior vena cava filter was placed immediately after the diagnosis was made, but the patient died on the fourth hospital day.