Risk-assessment and pharmacological prophylaxis of venous thromboembolism in hospitalized patients with chronic liver disease

Bogari, Hanin A.; Patanwala, Asad E.; Cosgrove, Richard; Katz, Michael G.

doi:10.1016/j.thromres.2014.09.031

Cited by 45 publications

(75 citation statements)

References 12 publications

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“…The Padua predictive score is a validated tool that can predict the risk of VTE and guide administration of thromboprophylaxis and has been studied in patients with cirrhosis. 83,84 Although nearly all patients admitted to the ICU are considered to be at a high risk of VTE, they may simultaneously be at a higher risk of developing bleeding complications. The IMPROVE (International Medical Prevention Registry on Venous Thromboembolism) risk assessment model was developed to assess both VTE and bleeding risk and did not exclude patients with liver disease in the original study cohort.…”

Section: Thrombosis In Acute and Chronic Liver Disease Nonsplanchnic mentioning

confidence: 99%

Coagulation Pathways, Hemostasis, and Thrombosis in Liver Failure

Intagliata

Davis

Caldwell

2018

Semin Respir Crit Care Med

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Achieving hemostasis, preventing and treating thrombosis, and laboratory measurement of the hemostatic pathways constitute the core elements of managing the critically ill patient with liver failure. Uncontrolled bleeding in acutely decompensated cirrhosis and acute-on-chronic liver failure is probably the most familiar clinical challenge to intensivists. Bleeding in these patients can be broadly divided into pressure-driven (portal hypertension-related) bleeding with only limited dependence on hemostatic pathways and intractable mucosal/wound bleeding, which is much more directly related to a severely disturbed hemostatic system with imbalances in the coagulation cascade and the fibrinolytic system. Both types of bleeding can occur simultaneously and may even coexist with inappropriate thrombosis such as portal vein thrombosis or venous thromboembolism. Due to the fundamental role of the liver in coagulation factor synthesis and its direct and indirect regulation of nearly all aspects of the hemostatic system, laboratory measurements of coagulation pathways also constitute key aspects of all prognostic scores that guide clinical decisions and forecast optimal interventions in both acute and chronic forms of liver failure.

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Section: Thrombosis In Acute and Chronic Liver Disease Nonsplanchnic mentioning

confidence: 99%

Coagulation Pathways, Hemostasis, and Thrombosis in Liver Failure

Intagliata

Davis

Caldwell

2018

Semin Respir Crit Care Med

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“…Risk stratification scores that have been validated to predict VTE within a general population of hospitalised patients also appear to accurately predict VTE specifically amongst hospitalised patients with chronic liver disease, i.e. Padua Predictor Score (Bogari et al, 2014). More surprisingly, an increased relative risk of VTE has been observed amongst those with chronic liver disease in a case control population based study (Søgaard et al, 2009).…”

mentioning

confidence: 99%

Anticoagulation in chronic liver disease

Dhar

Mullish

Thursz

2017

Journal of Hepatology

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“…14 Subsequent small retrospective cohort studies conducted in patients with cirrhosis have confirmed the accuracy of PPS for prediction of high-risk patients who develop VTE. 13,17 The IMPROVE risk score was developed in a large, heterogeneous cohort that included patients with liver disease, supporting its applicability in this population. In addition, a scoring system to predict bleeding risk (IMPROVE bleeding risk score) was developed that further aids in patient selection.…”

Section: Introductionmentioning

confidence: 94%

“…The PPS is most widely used scoring system, but the original cohort study excluded patients with advanced liver disease . Subsequent small retrospective cohort studies conducted in patients with cirrhosis have confirmed the accuracy of PPS for prediction of high‐risk patients who develop VTE . The IMPROVE risk score was developed in a large, heterogeneous cohort that included patients with liver disease, supporting its applicability in this population.…”

Section: Introductionmentioning

confidence: 99%

Overuse of venous thromboembolism prophylaxis among hospitalized patients with liver disease

Davis

O’Leary

Intagliata

2020

European J of Haematology

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Introduction Patients with liver disease are at risk of venous thromboembolism (VTE); however, little is understood regarding the safety and efficacy of VTE prophylaxis in patients with cirrhosis. We examined the application of a VTE risk assessment model in VTE prophylaxis decision‐making in a closed cohort of hospitalized patients with liver disease. Methods Sequential patients admitted to an inpatient hepatology service at a tertiary care center were evaluated for need for VTE prophylaxis. Risk assessment by IMPROVE was compared with current practice patterns of VTE prophylaxis. Rates of bleeding and clotting events were noted. Results 98 patient encounters were included in our analysis. 76% of patients received VTE prophylaxis in practice. IMPROVE recommended use of VTE prophylaxis in 19% of patients. Patients who received VTE prophylaxis that was not warranted had significantly lower risk of clotting compared with patients in whom VTE prophylaxis was warranted per IMPROVE. Conclusions Application of IMPROVE risk assessment would significantly reduce VTE prophylaxis use among hospitalized patients with liver disease. Our findings challenge the “one‐size‐fits‐all” current practice pattern of VTE prophylaxis. Future studies are needed in large cohorts of hospitalized patients with liver disease that include clinical outcomes of bleeding and clotting risk.

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Risk-assessment and pharmacological prophylaxis of venous thromboembolism in hospitalized patients with chronic liver disease

Cited by 45 publications

References 12 publications

Coagulation Pathways, Hemostasis, and Thrombosis in Liver Failure

Coagulation Pathways, Hemostasis, and Thrombosis in Liver Failure

Anticoagulation in chronic liver disease

Overuse of venous thromboembolism prophylaxis among hospitalized patients with liver disease

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