Related Experiment Video
Updated: Apr 17, 2026
New Thrombectomy Technique for Total Portal Vein Thrombosis in Liver Transplantation
Published on: June 27, 2025
Decision making in venous thromboembolism prophylaxis: Is LWMH being inappropriately withheld from patients admitted
Clement Lau1, Christian Burd1, Daniel Abeles1
1Gastroenterology and GI Surgery Centre, Central Middlesex Hospital, London, UK.
Insights
Patients with chronic liver disease (CLD) receive less venous thromboembolism (VTE) prophylaxis with low molecular weight heparin (LMWH) than other patients. Decisions to prescribe LMWH were influenced by admission type, not solely by clinical need.
Area of Science:
- Hepatology
- Cardiology
- Internal Medicine
Background:
- Chronic liver disease (CLD) is a common cause of hospital admission.
- Venous thromboembolism (VTE) risk may be underestimated in CLD patients.
- Prophylactic low molecular weight heparin (LMWH) may be safe and beneficial in CLD.
Purpose of the Study:
- To evaluate VTE prophylaxis in CLD patients.
- To identify factors influencing LMWH prescription decisions in CLD.
Main Methods:
- Retrospective analysis of LMWH prescription rates.
- Comparison between CLD and general medical patients.
- Analysis of factors associated with LMWH prescription in CLD.
Main Results:
- LMWH prescription was significantly lower in CLD patients (29%) compared to general medical patients (55%).
- CLD patients receiving LMWH were more likely to be admitted for non-liver reasons.
- Perceived contraindications may lead to underutilization of LMWH prophylaxis.
Conclusions:
- Many CLD patients who could benefit from LMWH prophylaxis do not receive it.
- LMWH prescription decisions are influenced by admission type.
- Prophylactic LMWH appears safe in CLD patients, warranting further investigation.
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.
Related Concept Videos
01:29Venous Thrombosis III: Interprofessional Care
01:30Anticoagulant Drugs: Low-Molecular-Weight Heparins
01:26Effect of Hepatic Disease on Pharmacokinetics: Drug Dosing and Hepatic Blood Flow
01:22Effect of Hepatic Disease on Pharmacokinetics: Pathophysiologic Assessment and Liver Function Test
01:30Venous Thrombosis IV: Nursing Management
01:28Esophageal Varices-II: Clinical Features and Management
In the initial assessment, a thorough review of the patient's medical history is vital to identify risk factors such as liver disease, alcohol...