Gastroenterology Research, ISSN 1918-2805 print, 1918-2813 online, Open Access
Article copyright, the authors; Journal compilation copyright, Gastroenterol Res and Elmer Press Inc
Journal website https://www.gastrores.org

Original Article

Volume 15, Number 2, April 2022, pages 67-74


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

Figure

Figure 1.
Figure 1. Study identification algorithm. VTE: venous thromboembolism.

Tables

Table 1. Baseline Characteristics of Included Patients With Liver Cirrhosis
 
CharacteristicPharmacologic VTE, prophylaxis percentage (n = 289)Non-pharmacologic VTE, prophylaxis percentage (n = 312)P value
VTE: venous thromboembolism; PBC: primary biliary cirrhosis; PSC: primary sclerosing cholangitis.
Median age65.6261.420.001
Male gender56.7% (164)66.7% (208)0.012
Race0.11
  White54.7% (158)59.6% (186)
  African American12.1% (35)7.4% (23)
  Asian3.1% (9)1.3% (4)
  Other/unavailable30.1% (87)31.7% (99)
Body mass index (kg/m2)28.038727.44240.328
Alcohol34.6% (100)47.1% (147)0.02
Tobacco11.1% (32)9.9% (31)0.649
Coronary artery disease21.1% (61)11.3% (35)0.001
Heart failure22.1% (64)11.2% (35)0.001
Chronic kidney disease13.8% (40)10.9% (34)0.273
End-stage renal disease7.3% (21)3.5% (11)0.041
Diabetes mellitus37.7% (109)29.8% (93)0.04
Hypertension61.6% (178)44.9% (140)0.001
Surgical procedure during admission11.5% (33)10.3% (32)0.636
Surgical procedure 6 months before admission9.3% (27)11.9% (37)0.304
Infection34.3% (99)24.4% (76)0.008
Intensive care unit stay12.8% (37)10.6% (33)0.395
Etiology of liver cirrhosis
  Nonalcoholic steatohepatitis12.1% (35)10.6% (33)0.563
  Alcohol34.9% (101)45.5% (142)0.008
  Hepatitis C21.5% (62)20.8% (65)0.852
  Other0.001
    Hepatitis B4.8% (14)5.4% (17)
    Hemochromatosis1.4% (4)1% (3)
    Autoimmune1% (3)2.2% (7)
    PBC2.8% (8)2.6% (8)
    PSC0.34 (1)0.64% (2)
    Cryptogenic7.6% (22)8% (25)
    Other13.56% (40)3.26% (10)
Esophageal varices9.8% (28)31% (95)0.001
Labs on admission
  Hemoglobin11.8810.710.001
  Platelets count172.031190.001
  INR1.331.53< 0.001
  Creatinine1.571.290.026
  Albumin3.112.930.003
  Sodium136.77137.460.131
  Bilirubin1.962.840.003
Ascites present on admission34.9% (101)46.9% (146)0.003
Hepatic encephalopathy16.3% (47)24.4% (76)0.014
Child-Pugh score7.247.920.507
Mean MELD-Na12.6113.39> 0.05

 

Table 2. The Impact of VTE Prophylaxis on the Incidence of VTE and Outcomes Among Subgroups of Hospitalized Cirrhotic Patients
 
Pharmacologic VTE prophylaxis (n = 289)No pharmacologic VTE prophylaxis (n = 312)P value
VTE: venous thromboembolism.
Primary outcome
  Total VTE0.7% (2)2.2% (7)0.118
  VTE during admission0.35% (1)1% (3)0.354
Secondary outcomes
  Bleeding2.8% (8)20.2% (63)< 0.001
  Transfusion12.5% (36)31.1% (97)< 0.001
  Hospital length of stay7.556.660.118
  6-month readmission38.8% (112)35.6% (111)0.420

 

Table 3. List of Hospitalized Cirrhotic Patients With Newly Diagnosed VTE: Risk Factors, Diagnostic Modality, Location, and Days to Diagnosis
 
CasesVTE prophylaxisLocationModality of diagnosisDays to VTE from admissionTreatment/interventionAgeGenderPlateletAlbuminINR
aApixaban was tried and was complicated by bleeding. VTE: venous thromboembolism; SCD: sequential compression device; IV: intravenous; SC: subcutaneous; PE: pulmonary embolism; CT: computed tomography; LMWH: low-molecular-weight heparin; F: female; M: male; INR: international normalized ratio.
1SCDRight brachial veinUltrasound duplex10None70F512.71.36
2SCDRight common femoralUltrasound duplex4None92M7731.43
3SCDLeft popliteal and left lower lobe PECT angiography and ultrasound duplex7IV heparin then Coumadin66F722.33.42
4SCDLeft portal veinCT scan with IV contrast5None61M382.31.42
5NoneRight common femoral veinUltrasound duplex4Inferior vena cava filter76M12131.46
6NoneLeft common femoral veinUltrasound duplex33Inferior vena cava filtera88F3732.70.94
7NoneLeft iliac veinUltrasound duplex2Patient refused treatment59F1443.11.05
8Heparin SCLeft femoral and popliteal veinsUltrasound duplex21LMWH SC37M2851.61.74
9Heparin SCLeft subclavian veinUltrasound duplex30Rivaroxaban61M1462.21.28