title: Decision making in venous thromboembolism prophylaxis: Is LWMH being inappropriately withheld from patients admitted with chronic liver disease?
abstract: Although chronic liver disease (CLD) constitutes a significant proportion of acute medical admissions, it is not known how CLD influences venous thromboembolism (VTE) prophylaxis decision making and low molecular weight heparin (LMWH) prescription. Furthermore, recent evidence suggests that VTE risk has been underestimated in CLD and that prophylactic LMWH is safe and may improve outcome in this patient group. We therefore evaluated VTE prophylaxis in patients with CLD and aimed to determine the factors contributing to decisions to prescribe LMWH. Prescription of LMWH was significantly less likely in CLD patients than in general medical patients (29% vs 55%; p < 0.01). Patients with CLD who were prescribed LMWH were more likely to have been admitted for a 'non-liver' reason than those that did not receive LMWH (19% vs 52%; p < 0.01). These preliminary results show that many patients admitted with CLD, who may benefit from LMWH prophylaxis, do not receive this therapy, because of perceived contraindications for which there may be little evidence. Decision making appears to be affected by whether an admission is 'liver' or 'non-liver' related. Prophylactic LMWH was safe in this small cohort. Further studies are warranted to further inform LMWH prescription in CLD.
authors: Gastroenterology and GI Surgery Centre, Central Middlesex Hospital, London, UK.
authors: Clement
authors: C
authors: Lau
authors: Gastroenterology and GI Surgery Centre, Central Middlesex Hospital, London, UK.
authors: Christian
authors: C
authors: Burd
authors: Gastroenterology and GI Surgery Centre, Central Middlesex Hospital, London, UK.
authors: Daniel
authors: D
authors: Abeles
authors: Gastroenterology and GI Surgery Centre, Central Middlesex Hospital, London, UK david.sherman@nhs.net.
authors: David
authors: D
authors: Sherman
mesh_terms: D002908:Chronic Disease / Q000453:epidemiology; D000075202:Contraindications; D005260:Female; D006471:Gastrointestinal Hemorrhage; D006495:Heparin, Low-Molecular-Weight / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D008107:Liver Diseases / Q000150:complications* / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D054556:Venous Thromboembolism / Q000188:drug therapy* / Q000517:prevention & control
chemical_list: D006495:Heparin, Low-Molecular-Weight
keywords: VTE prophylaxis; chronic liver disease; cirrhosis; coagulopathy
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