The efficacy and safety of venous thromboembolism prophylaxis among hospitalized cirrhotic patients: Systematic review and meta-analysis.

Abstract

Background and study aims: This meta-analysis aims to evaluate the effect of prophylactic anticoagulation on incidence of venous thromboembolism (VTE), bleeding events, and mortality in hospitalized cirrhotic patients.

Methods: We utilized the following databases (EMBASE, PubMed, MedRxiv and google-scholar) to search for studies that satisfied the reviewers pre-specified inclusion criteria. The incidence of VTE, bleeding risks, and mortality were assessed using a quality effect meta-analytic model.

Results: From screening of 539 studies, a total of 9 studies (n = 6275 patients) satisfied inclusion criteria. Our results suggested no significant difference in the primary outcome of VTE events in both groups of cirrhotic patients who received and did not receive anticoagulation for VTE prophylaxis, (OR:0.9, 95 % CI:0.50-1.62). Similarly, there was a non-significant reduced risk of bleeding events in hospitalized cirrhotic amongst patient cohorts receiving VTE prophylaxis compared to those who did not (OR:0.51, 95 % CI:0.22-1.14). Analysis of three studies showed no significant difference in mortality in both groups (OR 1.02, 95 % CI:0.8-1.31).

Conclusion: In a pooled examination of studies evaluating outcomes in patients exposed to VTE prophylactic anticoagulation, we found no significant difference in the burden of VTE or mortality between treated and untreated patients with chronic liver disease (CLD). The retrospective design of a plurality of studies enrolled in the review meant further prospective studies are needed to objectively ascertain the efficacy and safety of VTE prophylaxis amongst patient cohorts with CLD.