title: Risk of hemorrhage in patients with chronic liver disease and coagulopathy receiving pharmacologic venous thromboembolism prophylaxis.
abstract: OBJECTIVE
  To evaluate the impact of pharmacologic venous thromboembolism (VTE) prophylaxis on risk of hemorrhage while hospitalized in patients with chronic liver disease (CLD) and concurrent coagulopathy.
  
  
  METHODS
  Retrospective, multicenter chart review.
  
  
  METHODS
  Five hospital, university-affiliated network in eastern Pennsylvania.
  
  
  METHODS
  Patients admitted to the network from January 1, 2012, until December 31, 2012, with ICD-9 code consistent with CLD and elevated international normalized ratio of 1.5 or greater not secondary to anticoagulation.
  
  
  RESULTS
  Two hundred fifty-six patients met criteria for analysis, with 80 having received pharmacologic VTE prophylaxis and 176 having received no pharmacologic VTE prophylaxis. Differences were observed in the primary outcome of overall hemorrhage (composite of major and minor hemorrhage) for patients receiving VTE prophylaxis versus no VTE prophylaxis (17.5% vs 7.4%, p=0.02). Logistic regression revealed covariates independently associated with increased hemorrhage risk were pharmacologic VTE prophylaxis use (adjusted odds ratio [AOR] 3.64, p=0.004), increasing international normalized ratio (AOR 1.31, p=0.007), and decreasing platelet count (AOR 0.99, p=0.03).
  
  
  CONCLUSIONS
  Patients with CLD and concurrent coagulopathy receiving pharmacologic VTE prophylaxis are at an increased risk of overall hemorrhage. Clinical implications remain unclear secondary to the difference in rate of overall hemorrhage being driven primarily by a difference in minor hemorrhage. In addition, no difference was demonstrated in many assessed clinically relevant markers.
authors: Pharmacy Department, St. Luke's University Health Network, Bethlehem, Pennsylvania.
authors: Jacob A
authors: JA
authors: Reichert
authors: Peter F
authors: PF
authors: Hlavinka
authors: Jill C
authors: JC
authors: Stolzfus
mesh_terms: D000328:Adult; D000368:Aged; D001778:Blood Coagulation Disorders / Q000188:drug therapy / Q000453:epidemiology*; D058625:End Stage Liver Disease / Q000188:drug therapy / Q000453:epidemiology*; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D006470:Hemorrhage / Q000139:chemically induced / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D054556:Venous Thromboembolism / Q000453:epidemiology* / Q000517:prevention & control*
chemical_list: D005343:Fibrinolytic Agents
keywords: anticoagulant; chronic liver disease; cirrhosis; coagulopathy; enoxaparin; fondaparinux; hemorrhage; heparin; low-molecular weight heparin; venous thromboembolism