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

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 (59years vs. 55years, P<0.001), had longer lengths of stay (9.6days vs. 6.8days, 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.