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Evaluation of pharmacologic prophylaxis for venous thromboembolism in patients with chronic liver disease

Sean M Barclay1, Meghan N Jeffres, KimChi Nguyen

  • 1College of Pharmacy, Roseman University of Health Sciences, Henderson, Nevada 89104, USA. sbarclay@roseman.edu

Pharmacotherapy
|April 5, 2013
PubMed

Insights

Pharmacologic prophylaxis for venous thromboembolism (VTE) in chronic liver disease (CLD) patients reduced VTE incidence without increasing bleeding. This treatment should be considered for hospitalized CLD patients, especially those with malignancy or a history of VTE.

Area of Science:

  • Internal Medicine
  • Hepatology
  • Critical Care Medicine

Background:

  • Venous thromboembolism (VTE) is a significant concern in patients with chronic liver disease (CLD).
  • The efficacy and safety of pharmacologic VTE prophylaxis in this specific patient population require further investigation.

Purpose of the Study:

  • To evaluate the association between pharmacologic VTE prophylaxis and the incidence of VTE.
  • To assess the impact of pharmacologic VTE prophylaxis on bleeding rates in CLD patients.

Main Methods:

  • Retrospective cohort analysis of 1581 adult CLD patients hospitalized for over 24 hours.
  • Comparison of VTE and bleeding rates between patients who received pharmacologic VTE prophylaxis and those who did not.
  • Multivariate logistic regression to identify VTE risk factors and prophylaxis effectiveness.

Main Results:

  • Pharmacologic VTE prophylaxis was associated with a significantly lower incidence of VTE (0.5% vs 1.8%, p=0.05).
  • Bleeding rates were substantially lower in the prophylaxis group (2.0% vs 10.3%, p<0.001).
  • Active malignancy, recent trauma/surgery, and prior VTE were identified as key risk factors for VTE.

Conclusions:

  • Pharmacologic VTE prophylaxis is associated with reduced VTE incidence in CLD patients without increasing bleeding risk.
  • Routine consideration of VTE prophylaxis upon hospital admission for CLD patients is recommended.
  • Patients with CLD and specific risk factors (malignancy, trauma/surgery, prior VTE) warrant targeted prophylaxis.
Abstract

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