Published online Apr 27, 2019. doi: 10.4254/wjh.v11.i4.379
Peer-review started: January 10, 2019
First decision: March 5, 2019
Revised: March 22, 2019
Accepted: April 8, 2019
Article in press: April 8, 2019
Published online: April 27, 2019
Patients with liver disease are concomitantly at increased risk of venous thromboembolism (VTE) and bleeding events due to changes in the balance of pro- and anti-hemostatic substances. As such, recommendations for the use of pharmacological VTE prophylaxis are lacking. Recent studies have found no difference in rates of VTE in those receiving and not receiving pharmacological VTE prophylaxis, though most studies have been small. Thus, our study sought to establish if pharmacological VTE prophylaxis is effective and safe in patients with liver disease.
To determine if there is net clinical benefit to providing pharmacological VTE prophylaxis to cirrhotic patients.
In this retrospective study, 1806 patients were propensity matched to assess if pharmacological VTE prophylaxis is effective and safe in patients with cirrhosis. Patients were divided and evaluated based on receipt of pharmacological VTE prophylaxis.
The composite primary outcome of VTE or major bleeding was more common in the no prophylaxis group than the prophylaxis group (8.7% vs 5.1%, P = 0.002), though this outcome was driven by higher rates of major bleeding (6.9% vs 2.9%, P < 0.001) rather than VTE (1.9% vs 2.2%, P = 0.62). There was no difference in length of stay or in-hospital mortality between groups. Pharmacological VTE prophylaxis was independently associated with lower rates of major bleeding (OR = 0.42, 95%CI: 0.25-0.68, P = 0.0005), but was not protective against VTE on multivariable analysis.
Pharmacological VTE prophylaxis was not associated with a significant reduction in the rate of VTE in patients with liver disease, though no increase in major bleeding events was observed.
Core tip: While patients with cirrhosis have historically been considered to be coagulopathic, recent data suggests that these patients may be both hypo- and hypercoagulable. Recommendation for provision of chemoprophylaxis to prevent venous thromboembolism (VTE) in this group of patients is lacking. In our study, pharmacological VTE prophylaxis decreased composite rates of major bleeding and VTE but was not protective against VTE, further demonstrating the uncertain utility of chemoprophylaxis in this population.