S2568 Rising Venous Thromboembolism Mortality in Cirrhosis: A National Trend Analysis, 2000-2022

Introduction: This study explores the coagulation paradox in liver cirrhosis. While bleeding is common, we highlight rising evidence of clotting risk by using national VTE mortality trends from 2000–2022. This study provides the first trend analysis showing that VTE is now a rising cause of death in cirrhosis, challenging the long-held belief that these patients are “auto-anticoagulated. Methods: We used CDC WONDER data to identify cirrhosis deaths (International Classification of Diseases, Tenth Revision (ICD-10): K70, K74) with VTE (I26, I80–I82) as contributing causes from 2000–2022. Annual VTE proportions among cirrhosis deaths were calculated. Analysis and visualization were performed in R (v4.3.2) using ggplot2, dplyr, and scales to show rising VTE-related mortality in cirrhosis. Results: Between 2000 and 2022, the proportion of cirrhosis deaths with VTE increased from 0.7% to 2.0%, marking a nearly threefold increase. Pulmonary embolism was the leading thrombotic event, with fatality rates doubling in cirrhotic patients compared to non-cirrhotic patients. The trend aligns with improved survival among patients with cirrhosis and the underuse of thromboprophylaxis. Conclusion: Historically, cirrhosis is thought to be an auto-anticoagulated state, but recent studies reveal a tendency toward hypercoagulability. Pulmonary embolism is a leading thrombotic event causing death in cirrhotic patients. In studies comparing causes, NASH cirrhosis has the highest risk of VTE, which highlights the need for closer monitoring. Although vitamin K antagonists carry a bleeding risk, their use is associated with improved survival. Notably, the rate of bleeding was the same in the absence of vitamin K antagonist treatment, suggesting that portal hypertension, rather than anticoagulation, may be the primary cause of upper gastrointestinal bleeding (UGIB). Between 2000–2022, VTE-related deaths rose from 350 to over 1,000, with the increase more pronounced in patients aged 45–64 years. The rising thrombotic burden reflects possible underutilization of thromboprophylaxis in hospitalized and high-risk patients. Lastly, anticoagulation regimens should be individualized depending on the severity of the underlying condition based on the Child–Pugh classification. There is an urgent need for prospective studies to evaluate VTE prevention strategies in cirrhotic patients.