Safety and efficacy of pharmacological thromboprophylaxis for hospitalized patients with cirrhosis: a single‐center retrospective cohort study

Abstract

Safety and efficacy of pharmacological thromboprophylaxis for hospitalized patients with cirrhosis: a single-center retrospective cohort study. J Thromb Haemost 2015; 13: 1245-53. Summary. Background: Hospitalized patients with cirrhosis are at increased risk for venous thromboembolism (VTE). The benefits and risks of pharmacological thromboprohylaxis in these patients have not been well studied. Objectives: To examine the safety and efficacy of pharmacological VTE prophylaxis in hospitalized cirrhotic patients. Patients/Methods: Retrospective cohort study of patients with cirrhosis hospitalized at an academic tertiary care referral center over a 5-year period. Results: Six hundred hospital admissions accounting for 402 patients were included. VTE prophylaxis was administered during 296 (49%) admissions. Patients receiving VTE prophylaxis were older (59 years vs. 55 years, P < 0.001), had longer lengths of stay (9.6 days vs. 6.8 days, P = 0.002), and lower Model for End-Stage Liver Disease scores (13.2 vs. 16.1, P < 0.001). In-hospital bleeding events (8.1% vs. 5.5%, P = 0.258), gastrointestinal bleeding events (3.0% vs. 3.2% P = 0.52), new VTE events (2.37% vs. 1.65%, P = 0.537), and mortality (8.4% vs. 7.3%, P = 0.599) were similar in the two groups. VTE prophylaxis did not reduce the risk of VTE (odds ratio 0.94, 95% confidence interval 0.23-3.71), and patients receiving unfractionated heparin, but not low molecular weight heparin, were at increased risk for in-hospital bleeding events (odds ratio 2.38, 95% confidence interval 1. 15-4.94 vs. 0.87, 0.37-2.05, respectively). Conclusion: The rate of VTE in this cohort of hospitalized cirrhotic patients was low and was unaffected by pharmacological thromboprophylaxis. Unfractionated heparin was associated with an increased risk for in-hospital bleeding, suggesting that if thromboprophylaxis is indicated, low molecular weight heparin may be favored.

The efficacy and safety of direct oral anticoagulants vs traditional anticoagulants in cirrhosis

“…Many authors suggest LMWH as the anticoagulant of choice in patients with liver disease, based on small prospective series and retrospective evaluations . VKAs alternately are difficult to monitor in cirrhotic patients with baseline coagulopathy, leading to the threat of significant time outside of therapeutic range .…”

Transfusion strategies in patients with cirrhosis

“…thrombopoietin, the main regulator of platelet production, is also hepatically synthesized. This coupled with splenomegaly from portal hypertension often results in the characteristic thrombocytopenia of liver disease . In the last several decades, there has been increasing awareness that the decreased level of procoagulants in cirrhosis is also accompanied by reductions in levels of anticoagulants; a concept termed “rebalanced hemostasis” .…”

Clinical effect of enoxaparin on international normalized ratio following hepato‐pancreatico‐biliary and gastroesophageal resection

“…However, in a study of 402 cirrhotic patients they determined that patients receiving unfractionated heparin were at risk for in‐hospital bleeding, but patients receiving low‐molecular‐weight heparin were not, Odds Ratio 2.38 (1.15‐4.94) and 0.87 (0.37‐2.05), respectively . These findings that seem to be contradictory could in fact have a common thread that explains the outcomes: the INR.…”