The Incidence of Venous Thromboembolism and Practice of Deep Venous Thrombosis Prophylaxis Among Hospitalized Cirrhotic Patients

IF 1.4 Q4 GASTROENTEROLOGY & HEPATOLOGY
Mira Alsheikh, K. Kamar, Malek Kreidieh, Rola Sasso, Samragnyi Madala, Rubal Sharma, Hassan Al Moussawi, L. Deeb
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引用次数: 4

Abstract

Background Patients with liver cirrhosis have altered hepatic synthetic functions which theoretically result in reduced levels of pro-and anti-coagulant factors as well as thrombocytopenia. Initially, cirrhotic patients were thought to be at an increased risk of bleeding and a reduced risk of thrombosis. Several studies have recently reported an increased occurrence of venous thromboembolism (VTE) in cirrhotic patients. In this study, we aimed to assess the current practice of deep venous thrombosis (DVT) prophylaxis, the incidence and predictors of VTE, and the associated bleeding sequelae in patients with liver cirrhosis. Methods A retrospective cohort study was performed. We included all adult patients with a diagnosis of liver cirrhosis from January 2010 to June 2019 admitted to the hospital. Our cohort patients were divided into two groups, cirrhotic patients with pharmacological VTE prophylaxis and those with mechanical or no VTE prophylaxis. Results We included 601 cirrhotic patients in our study. The incidence of VTE occurring within the first 6 months of their admission was 1.5%. Seven patients (1.49%) developed VTE with the majority being DVTs while not on pharmacologic prophylaxis, and two patients developed VTE despite being on pharmacologic prophylaxis; however, there was no statistical difference. Alcohol use was the most common underlying cause of liver cirrhosis (40.4%), followed by chronic hepatitis C (21.1%), and nonalcoholic steatohepatitis (11.3%). Out of the 601 patients included, 69 patients received neither pharmacologic nor mechanical VTE prophylactic agent (11.48%), while the remaining majority received either pharmacological or mechanical prophylaxis (88.52%). Conclusions Our study did not show a statistically significant association between the use of pharmacological VTE prophylactic agents and a reduction in the risk of VTE in cirrhotic patients. The rates of usage of DVT prophylactic agents among our Northwell hospitals during the study period appeared to be no longer suboptimal when compared to prior studies. Low albumin appears to be a predictor factor to develop VTE. There was a statistically significant increase in bleeding risk and transfusion requirement in cirrhotic patients receiving no pharmacological VTE prophylactic agents. Further prospective trials are needed to shed more light on this subject and identify the group of cirrhotic patients who could safely benefit from pharmacologic VTE prophylaxis.
住院肝硬化患者静脉血栓栓塞发生率及深静脉血栓预防实践
背景肝硬化患者的肝脏合成功能发生了改变,理论上导致促凝血因子和抗凝血因子水平降低以及血小板减少。最初,肝硬化患者被认为出血风险增加,血栓形成风险降低。最近几项研究报告了肝硬化患者静脉血栓栓塞(VTE)的发生率增加。在本研究中,我们旨在评估肝硬化患者预防深静脉血栓形成(DVT)的当前实践、VTE的发生率和预测因素,以及相关的出血后遗症。方法采用回顾性队列研究。我们纳入了2010年1月至2019年6月入院的所有诊断为肝硬化的成年患者。我们的队列患者被分为两组,一组是药物预防性VTE的肝硬化患者,另一组是机械或无VTE预防的肝硬化患者。结果本研究纳入601例肝硬化患者。VTE发生在入院后的前6个月内的发生率为1.5%。7名患者(1.49%)发生了VTE,其中大多数是未进行药物预防的DVT,2名患者尽管进行了药物预防,但仍发生了VTE;但没有统计学差异。饮酒是肝硬化最常见的潜在原因(40.4%),其次是慢性丙型肝炎(21.1%)和非酒精性脂肪性肝炎(11.3%)。在601名患者中,69名患者既没有服用药物也没有服用机械性VTE预防剂(11.48%),而其余大多数患者接受了药物或机械预防(88.52%)。结论我们的研究没有显示使用药物VTE预防剂与降低肝硬化患者VTE风险之间的统计学显著相关性。与之前的研究相比,在研究期间,我们的Northwell医院中DVT预防剂的使用率似乎不再是次优的。低白蛋白似乎是发生VTE的一个预测因素。在没有服用药物VTE预防剂的肝硬化患者中,出血风险和输血需求在统计学上显著增加。需要进一步的前瞻性试验来阐明这一主题,并确定可以安全地从药物VTE预防中获益的肝硬化患者群体。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Gastroenterology Research
Gastroenterology Research GASTROENTEROLOGY & HEPATOLOGY-
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