Abstract
Background
The coagulation cascade is disturbed in cirrhosis. Patients are at risk for bleeding and coagulation through an imbalance of pro and anticoagulant factors.
Aims
We evaluated the incidence of DVTs and prevalence of DVT prophylaxis in hospitalized patients with decompensated cirrhosis.
Methods
A retrospective study of decompensated cirrhotic patients admitted to a tertiary care hospital. We evaluated the incidence of DVTs and use of DVT prophylaxis in this cohort. We also evaluated differences in patient characteristics in those who received DVT prophylaxis and between patients who did or did not develop DVTs.
Results
This study consisted of 520 cirrhotic patients, of which 258 patients (49.6%) received DVT prophylaxis. Of the remaining 262 patients who did not receive DVT prophylaxis, 199 (75.9%) had a documented contraindication to prophylaxis (bleeding, thrombocytopenia, both, or other). Compared to patients without DVT prophylaxis, patients who received prophylaxis were older (61.2 ± 11.2 vs 56.6 ± 10.9, p= 0.00001), had less varices (16.2% vs. 46%, p=0.0048), had more severe liver disease (MELD-Na 21 ± 6.5 vs 19.7 ± 7.3, p = 0.032), and fewer incidents of variceal (3.4% vs. 35.1%, p <0.001) and non-variceal (5.4% vs. 17.1%, p <0.001) gastrointestinal bleeding. DVT prophylaxed patients also had higher mean platelet values (149 ± 89 vs 112 ± 84, p <0.001), but similar baseline INRs (1.6 ± 0.4 vs 1.7 ± 0.8, p= 0.16), and were more likely to be admitted for non-bleeding complications of liver disease, including incidence of hepatic encephalopathy (37.9% vs 25.1%, p = 0.002) and spontaneous bacterial peritonitis (12.1% vs 6.5%, p=0.029). The incidence of radiographically identified DVT events in cirrhotic patients receiving DVT prophylaxis and those not receiving DVT prophylaxis was similar at 1.1 and 0.7%, respectively (OR 1.52, 95% CI 0.254 to 9.1, p = 0.65). There was no difference in liver disease severity between those with DVTs to those who did not develop DVTs, including similar MELD-Na, INR, platelets and hemoglobin values. Compared to patients without DVTs, those who developed DVTs had a higher bilirubin (95.8 ± 78.0 vs. 64.1 ± 24, p = 0.202) and INR (2.1 ± 0.7 vs. 1.6 ± 0.6, p = 0.07), as well as lower platelets (81.8 ± 23.3 vs. 131.4 ± 88.9). These groups had comparatively similar MELD-Na, albumin, creatinine, and hemoglobin levels.
Conclusions
DVT prevalence in this cohort of decompensated liver disease patients was overall low. DVT prophylaxis rates were moderate overall, however taking into account perceived contraindications such as thrombocytopenia or bleeding, patients appeared to be appropriately prophylaxed when indicated. Further study is required to identify which cirrhotic patients are at highest risk for DVTs and the safety of prophylaxis among patients with deranged lab values such as low platelets and elevated INR.
Funding Agencies
None
Combination of vial culture and broad-range PCR for the diagnosis of spontaneous bacterial peritonitis: experience in a Greek tertiary care hospital