Prophylactic anticoagulation for venous thromboembolism in hospitalized cirrhosis patients is not associated with high rates of gastrointestinal bleeding

Authors

  • Nicolas M. Intagliata,

    Corresponding author
    1. Division of Gastroenterology and Hepatology, Center for Coagulation Disorders in Liver Disease, University of Virginia, Charlottesville, VA, USA
    • Correspondence

      Nicolas Intagliata, MD, Division of Gastroenterology and Hepatology, Center for Coagulation Disorders in Liver Disease, University of Virginia, P.O. Box 800708, Charlottesville, VA 22908 USA

      Tel: + 434 924 2959

      Fax: + 434 244 7529

      e-mail: intagliata@virginia.edu

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  • Zachary H. Henry,

    1. Division of Gastroenterology and Hepatology, Center for Coagulation Disorders in Liver Disease, University of Virginia, Charlottesville, VA, USA
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  • Neeral Shah,

    1. Division of Gastroenterology and Hepatology, Center for Coagulation Disorders in Liver Disease, University of Virginia, Charlottesville, VA, USA
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  • Ton Lisman,

    1. Department of Surgery, Section of Hepatobiliary Surgery and Liver Transplantation, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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  • Stephen H. Caldwell,

    1. Division of Gastroenterology and Hepatology, Center for Coagulation Disorders in Liver Disease, University of Virginia, Charlottesville, VA, USA
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  • Patrick G. Northup

    1. Division of Gastroenterology and Hepatology, Center for Coagulation Disorders in Liver Disease, University of Virginia, Charlottesville, VA, USA
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Abstract

Background

Hospitalized patients with cirrhosis are at risk to develop venous thromboembolism. Although current guidelines support the routine administration of thromboprophylaxis to hospitalized patients, there is limited data regarding the safety or efficacy of this practice in hospitalized cirrhosis patients.

Aims

We aimed to determine if administration of thromboprophylaxis was associated with increased complication rates for hospitalized cirrhosis patients.

Methods

Data were collected on patients admitted to the University of Virginia between 2007 and 2010. Study personnel systematically collected data on complications, including gastrointestinal bleed, venous thromboembolism and death directly from the medical record.

Results

A total of 235 patients (accounting for 355 discrete hospitalizations in which thromboprophylaxis was administered) met inclusion criteria accounting for 1660 person-days of thromboprophylaxis administered to patients. The mean age at admission was 58 (95% CI 57.1–59.2) years and 217 (61%) were male patients. The mean admission model for end-stage liver disease (MELD) score was 16.2 (95% CI 15.5–16.9). The mean hospital length of stay was 6.5 (95% CI 5.9–7.4) days. In patients who received thromboprophylaxis, the mean treatment length was 4.7 days (95% CI 4.2–5.2). There were nine gastrointestinal bleeding events (2.5% of admissions), five venous thromboembolisms (1.4% of admissions), two cases of heparin-induced thrombocytopenia (0.5% of admissions) and 14 deaths overall (3.9% of admissions).

Conclusions

The use of thromboprophylaxis in hospitalized cirrhosis patients is not associated with high rates of gastrointestinal bleeding or death.

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