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

Abstract

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.

Keywords: cirrhosis; low molecular weight heparin; prophylaxis; unfractionated heparin; venous thromboembolism.

Fig. 1.

Inclusion/exclusion schema. Nine hundred ninety-six hospital admissions were identified for potential inclusion in the study, and 600 admissions involving 402 unique patients qualified for entry. *The unique patient number includes 66 patients with multiple admissions who received VTE prophylaxis during some admissions but not during others. These patients are therefore included in both the prophylaxis and no-prophylaxis groups, accounting for 235 and 233 patients, respectively.