Work

Incident venous thromboembolism in biopsy-proven metabolic dysfunction-associated steatotic liver disease: a nationwide cohort study

Year: 2026

Type: article

Abstract: BACKGROUND: The absolute and relative risk of venous thromboembolism (VTE) in individuals with metabolic dysfunction-associated steatotic liver disease (MASLD) remains largely unexplored. We conducted a nationwide cohort study to explore this. OBJECTIVES: To calculate risk of developing VTE among MASLD. METHODS: This nationwide, population-based matched cohort study in Sweden included all individuals with biopsy-confirmed MASLD (1965-2017). MASLD was histologically classified into simple steatosis, metabolic dysfunction-associated steatohepatitis, noncirrhotic fibrosis, and cirrhosis. Each MASLD case was matched to up to 5 general population comparators. VTE events were identified using the Swedish National Patient Register up until 2021. RESULTS: We included 11 073 individuals with MASLD and 50 078 comparators. During a median follow-up of 18.6 years, incident VTE occurred in 1291 patients with MASLD and 4067 comparators. The incidence rate of VTE was higher in MASLD (7.6 vs 3.4 per 1000 person-years [PYs]), yielding an adjusted hazard ratio (aHR) of 1.78 (95% CI, 1.65-1.91). The absolute risk difference was 3.9 per 1000 PYs, equating to 1 extra VTE per 26 patients with MASLD over 10 years. MASLD was associated with a higher incidence of VTE triggered by cancer, hospitalization, and surgery. Higher aHRs were observed in women compared with men, and in patients with baseline cancer or metabolic disorders compared with those without. The risk of portal vein thrombosis was markedly elevated (aHR, 3.40; 95% CI, 2.93-3.95), increasing progressively with MASLD severity (P = .003). Findings were similar when siblings were used as comparators to account for intrafamilial confounding. CONCLUSION: Biopsy-confirmed MASLD was associated with a higher incidence of VTE, particularly portal vein thrombosis.

Source: Journal of Thrombosis and Haemostasis

DOI: 10.1016/j.jtha.2026.04.019