The incidence of venous thromboembolism and practice of deep venous thrombosis prophylaxis in hospitalized cirrhotic patients

Abstract

BackgroundCirrhotic patients are characterized by a decreased synthesis of coagulation and anticoagulation factors. The coagulopathy of cirrhotic patients is considered to be auto-anticoagulation. Our aim was to determine the incidence and predictors of venous thromboembolism (VTE) and examine the practice of deep venous thrombosis (DVT) prophylaxis among hospitalized cirrhotic patients.MethodsA retrospective cohort study was performed in a tertiary teaching hospital. We included all adult patients admitted to the hospital with a diagnosis of liver cirrhosis from January 1, 2009 to December 31, 2009. We grouped our cohort patients in two groups, cirrhotic patients without VTE and cirrhotic with VTE.ResultsOver one year, we included 226 cirrhotic patients, and the characteristics of both groups were similar regarding their clinical and laboratory parameters and their outcomes. Six patients (2.7%) developed VTE, and all of the VTEs were DVT. Hepatitis C was the most common (51%) underlying cause of liver cirrhosis, followed by hepatitis B (22%); 76% of the cirrhotic patients received neither pharmacological nor mechanical DVT prophylaxis.ConclusionCirrhotic patients are at risk for developing VTE. The utilization of DVT prophylaxis was suboptimal.

Hemostatic balance in patients with liver cirrhosis: Report of a consensus conference

“…Estimates of VTE in patients with cirrhosis are discordant [42,43,[166][167][168][169][170][171][172][173][174][175][176], due to retrospective collection of data, high heterogeneity of patients' characteristics, and study design. Reported rates range from 0.5% to 6.7% for incidence (Table 2), and from 0.6% to 4.7% for prevalence (Table 3), with higher values in patients with more severe liver disease [173] and in those with hepatocellular carcinoma [176].…”

Therapeutic and clinical aspects of portal vein thrombosis in patients with cirrhosis

“…For instance, thromboprophylaxis for the prevention of deep vein thrombosis should be given to cirrhosis patients, as to the general population, when exposed to such risk factors as immobilization, cancer or surgery [22,23] . However, such strategy is still not generally adopted in cirrhosis, due to the perceived risk of hemorrhage.…”

Emerging Issues in Deep Vein Thrombosis; (DVT) in Liver Disease and in Developing Countries

“…No significant differences in the incidence of VTE were observed between the group that received pharmacologic or mechanical prophylaxis and the group that did not receive prophylaxis (Abdulaziz et al, 2011). The utilization of DVT prophylaxis was suboptimal.…”