Association of Early Heparin Use with Mortality in Cirrhotic Patients: A Retrospective Cohort Study.

Abstract

Background/aims: Controversy remains regarding anticoagulant use to improve the prognosis of cirrhosis. Herein, we evaluated the effect of early use of unfractionated heparin (UFH) on survival in cirrhotic patients.

Materials and methods: Data were acquired from the Medical Information Mart for Intensive Care-IV database. Patients were allocated into early heparin and control groups according to the presence of UFH treatment within 48 hours following intensive care unit admissions. Effects of early UFH use on survival in cirrhotic patients were assessed using Kaplan-Meier survival curves with the log-rank test and Cox proportional hazards model. Associations between UFH use and the risk of red blood cell (RBC) transfusion were determined with the logistic regression model. The robustness of the results was assured with propensity score matching (PSM).

Results: This study included 1652 cirrhotic patients (781 and 871 in the early heparin and control groups, respectively). At 30-day followup, mortality was prominently lower in the early heparin group than in the control group (P < .001). Furthermore, early heparin use was associated with diminished 30-day mortality (hazards ratio [HR]: 0.742; 95% CI: 0.599-0.919; P = .006). This result was robust even after PSM (HR: 0.729; 95% CI: 0.568-0.937; P = .014). UFH use was not strikingly associated with an augmented risk of transfusion before (odds ratio [OR]: 0.917; 95% CI: 0.693-1.215; P = .547) and after (OR: 0.857; 95% CI: 0.616-1.191; P = .357) PSM.

Conclusion: Early heparin use was associated with reduced 30-day mortality among cirrhotic patients, without increasing the risk of RBC transfusion.