Evaluation of venous thromboembolism prophylaxis in patients with chronic liver disease.

Abstract

BACKGROUND: The incidence of venous thromboembolism (VTE) in chronic liver disease (CLD) patients has been reported to be 0.5% to 6.3%. Studies report the use of thromboprophylaxis in CLD patients as suboptimal, with at least 75% of patients receiving no prophylaxis. OBJECTIVE: To describe the use of VTE prophylaxis in CLD patients. DESIGN: A retrospective review. SETTING: Tertiary-care academic medical center. PATIENTS: Inpatient admissions from August 2009 through July 2011 with CLD diagnosis. INTERVENTION: None. MEASUREMENTS: Initiation and type of thromboprophylaxis, incidence of VTE, bleeding events, hospital length of stay, in-hospital mortality, 30-day readmission for VTE. RESULTS: Of the 410 patients included, 225 (55%) patients received thromboprophylaxis. For patients with international normalized ratio (INR) >2.0, a significant decrease in overall thromboprophylaxis use and pharmacologic prophylaxis use was seen compared to those with INR 1.4 to 2.0 (P = 0.013 and P < 0.001, respectively). Overall incidence of VTE was 0.7%. Fifteen bleeding events occurred (3.7%): 9 on mechanical prophylaxis, 1 on pharmacologic, 3 on combination, and 2 with no prophylaxis. The majority of patients experiencing a bleeding event had an INR >2.0 (P = 0.001). CONCLUSION: The use of thromboprophylaxis in CLD patients is higher in our study than previous reports but remains suboptimal. Use of VTE pharmacologic prophylaxis does not appear to increase bleeding in CLD patients with INR ≤2.0. Further studies are needed to provide additional safety data.