title: Safety and efficacy of pharmacological thromboprophylaxis for hospitalized patients with cirrhosis: a single-center retrospective cohort study.
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.
  
  
  OBJECTIVE
  To examine the safety and efficacy of pharmacological VTE prophylaxis in hospitalized cirrhotic 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 (59 years vs. 55 years, P < 0.001), had longer lengths of stay (9.6 days vs. 6.8 days, 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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Medicine, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA.
authors.forename: J
authors.initials: J
authors.lastname: Shatzel
authors.affiliation: Department of Medicine, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA.
authors.forename: P S
authors.initials: PS
authors.lastname: Dulai
authors.affiliation: Geisel School of Medicine at Dartmouth, Hanover, NH, USA.
authors.forename: D
authors.initials: D
authors.lastname: Harbin
authors.affiliation: Geisel School of Medicine at Dartmouth, Hanover, NH, USA.
authors.forename: H
authors.initials: H
authors.lastname: Cheung
authors.affiliation: Geisel School of Medicine at Dartmouth, Hanover, NH, USA.
authors.forename: T N
authors.initials: TN
authors.lastname: Reid
authors.affiliation: Geisel School of Medicine at Dartmouth, Hanover, NH, USA.
authors.forename: J
authors.initials: J
authors.lastname: Kim
authors.affiliation: Geisel School of Medicine at Dartmouth, Hanover, NH, USA.
authors.forename: S L
authors.initials: SL
authors.lastname: James
authors.affiliation: Geisel School of Medicine at Dartmouth, Hanover, NH, USA.
authors.forename: H
authors.initials: H
authors.lastname: Khine
authors.affiliation: Geisel School of Medicine at Dartmouth, Hanover, NH, USA.
authors.forename: S
authors.initials: S
authors.lastname: Batman
authors.affiliation: Department of Medicine, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA.
authors.forename: J
authors.initials: J
authors.lastname: Whyman
authors.affiliation: Department of Medicine, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA.|Geisel School of Medicine at Dartmouth, Hanover, NH, USA.
authors.forename: R C
authors.initials: RC
authors.lastname: Dickson
authors.affiliation: Department of Medicine, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA.|Geisel School of Medicine at Dartmouth, Hanover, NH, USA.|Department of Pathology, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA.
authors.forename: D L
authors.initials: DL
authors.lastname: Ornstein
mesh_terms: D000046:Academic Medical Centers; D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects; D004334:Drug Administration Schedule; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000139:chemically induced; D006495:Heparin, Low-Molecular-Weight / Q000008:administration & dosage; D006760:Hospitalization; D006801:Humans; D007902:Length of Stay; D008103:Liver Cirrhosis / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D009513:New Hampshire; D016017:Odds Ratio; D012189:Retrospective Studies; D012307:Risk Factors; D062606:Tertiary Care Centers; D013997:Time Factors; D016896:Treatment Outcome; D054556:Venous Thromboembolism / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*
chemical_list: D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight
keywords: cirrhosis; low molecular weight heparin; prophylaxis; unfractionated heparin; venous thromboembolism