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

J. Shatzel, P. S. Dulai, D. Harbin, H. Cheung, T. N. Reid, J. Kim, S. L. James, H. Khine, S. Batman, J. Whyman, Rolland Dickson, D. L. Ornstein

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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 (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.

Original languageEnglish (US)
Pages (from-to)1245-1253
Number of pages9
JournalJournal of Thrombosis and Haemostasis
Volume13
Issue number7
DOIs
StatePublished - Jul 1 2015
Externally publishedYes

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Venous Thromboembolism
Fibrosis
Cohort Studies
Retrospective Studies
Pharmacology
Safety
Hemorrhage
Low Molecular Weight Heparin
Tertiary Care Centers
Heparin
Odds Ratio
Confidence Intervals
End Stage Liver Disease
Length of Stay
Mortality

Keywords

  • Cirrhosis
  • Low molecular weight heparin
  • Prophylaxis
  • Unfractionated heparin
  • Venous thromboembolism

ASJC Scopus subject areas

  • Hematology

Cite this

Safety and efficacy of pharmacological thromboprophylaxis for hospitalized patients with cirrhosis : A single-center retrospective cohort study. / Shatzel, J.; Dulai, P. S.; Harbin, D.; Cheung, H.; Reid, T. N.; Kim, J.; James, S. L.; Khine, H.; Batman, S.; Whyman, J.; Dickson, Rolland; Ornstein, D. L.

In: Journal of Thrombosis and Haemostasis, Vol. 13, No. 7, 01.07.2015, p. 1245-1253.

Research output: Contribution to journalArticle

Shatzel, J, Dulai, PS, Harbin, D, Cheung, H, Reid, TN, Kim, J, James, SL, Khine, H, Batman, S, Whyman, J, Dickson, R & Ornstein, DL 2015, 'Safety and efficacy of pharmacological thromboprophylaxis for hospitalized patients with cirrhosis: A single-center retrospective cohort study', Journal of Thrombosis and Haemostasis, vol. 13, no. 7, pp. 1245-1253. https://doi.org/10.1111/jth.13000
Shatzel, J. ; Dulai, P. S. ; Harbin, D. ; Cheung, H. ; Reid, T. N. ; Kim, J. ; James, S. L. ; Khine, H. ; Batman, S. ; Whyman, J. ; Dickson, Rolland ; Ornstein, D. L. / Safety and efficacy of pharmacological thromboprophylaxis for hospitalized patients with cirrhosis : A single-center retrospective cohort study. In: Journal of Thrombosis and Haemostasis. 2015 ; Vol. 13, No. 7. pp. 1245-1253.
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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 (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.",
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T1 - Safety and efficacy of pharmacological thromboprophylaxis for hospitalized patients with cirrhosis

T2 - A single-center retrospective cohort study

AU - Shatzel, J.

AU - Dulai, P. S.

AU - Harbin, D.

AU - Cheung, H.

AU - Reid, T. N.

AU - Kim, J.

AU - James, S. L.

AU - Khine, H.

AU - Batman, S.

AU - Whyman, J.

AU - Dickson, Rolland

AU - Ornstein, D. L.

PY - 2015/7/1

Y1 - 2015/7/1

N2 - 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.

AB - 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.

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KW - Low molecular weight heparin

KW - Prophylaxis

KW - Unfractionated heparin

KW - Venous thromboembolism

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