Evaluation of pharmacologic prophylaxis for venous thromboembolism in patients with chronic liver disease

Sean M Barclay, Meghan N Jeffres, KimChi Nguyen, Tamdan Nguyen
Pharmacotherapy 2013, 33 (4): 375-82

STUDY OBJECTIVE: To determine whether pharmacologic prophylaxis for venous thromboembolism (VTE) was associated with a decrease in the incidence of VTE or an increased incidence of bleeding in patients with chronic liver disease (CLD).

DESIGN: Single-center, retrospective cohort analysis.

SETTING: University medical center.

PATIENTS: A total of 1581 adults with CLD hospitalized over a 3-year period for longer than 24 hours.

MEASUREMENTS AND MAIN RESULTS: Medical records were reviewed for the primary outcome of VTE and documented episodes of bleeding during hospitalization and were divided into two groups based on receipt of pharmacologic VTE prophylaxis. During the 1581 hospitalizations, 392 (24.7%) patients received pharmacologic VTE prophylaxis. The incidence of VTE in the prophylaxis group was 0.5% compared with 1.8% in patients without prophylaxis (p=0.05). Documented bleeding rates were lower in the prophylaxis group (2.0% vs 10.3%, p<0.001). Multivariate logistic regression identified active malignancy (odds ratio [OR] 8.76, 95% confidence interval [CI], 2.56-29.58), trauma or surgery during hospitalization (OR 10.29, 95% CI 1.18-89.51), and history of VTE (OR 26.48, 95% CI 6.93-101.16) as risk factors of VTE. Use of pharmacologic VTE prophylaxis was protective against VTE (OR 0.34, 95% CI 0.04-0.88).

CONCLUSION: Pharmacologic VTE prophylaxis was associated with a decreased incidence of VTE in patients with CLD without an increased rate of bleeding and should be routinely considered on admission to the hospital. Patients with CLD and active malignancy, trauma or surgery during hospitalization, or history of VTE appear to be at highest risk of VTE and thus warrant pharmacologic prophylaxis. Prospective studies must validate these findings.

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