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

Abstract

Introduction: There is a lack of evidence regarding the need for thromboprophylaxis in hospitalized patients with liver disease. The purpose of this study was to evaluate the Padua Predictor Score (PPS) as a risk-stratification tool for the development of venous thromboembolism (VTE) in patients with chronic liver disease.

Methods: This was a retrospective cohort study conducted in an academic medical center in the United States. Consecutive adult patients admitted with chronic liver disease were included. Patients were categorized into two groups based on whether they developed a VTE or not. The risk for VTE in each patient was evaluated using the Padua Predictor Score (PPS). Patients were risk stratified using the PPS score as high-risk (score ≥4) and low-risk (score <4). The risk of VTE based on PPS categorization was evaluated using logistic regression.

Results: A total of 163 patients with liver disease were included in the study cohort. Of these, 18 (11%) developed VTE. Mean PPS was significantly greater in the VTE group than the non-VTE group (5.8 ± 2.0 versus 3.0 ± 2.1, respectively; p<0.001). In high-risk patients 22% (n=16/72) developed VTE and in low-risk patients 2% (2/91) developed VTE (p<0.001). High-risk patients were more likely to have VTE (OR 12.7, 95% CI 2.8 to 57.4, p=0.001).

Conclusion: The PPS is an effective risk assessment tool for VTE in patients hospitalized with chronic liver disease.

Keywords: Anticoagulants; Heparin; Liver cirrhosis; Liver diseases; Thromboembolism; Venous thromboembolism.