Safety and efficacy of pharmacological thromboprophylaxis for hospitalized patients with cirrhosis: a single‐center retrospective cohort study
Summary Background Hospitalized patients with cirrhosis are at increased risk for venous thromboembolism (VTE). The benefits and risks of pharmacological thromboprohylaxis in these patients have not been well studied. Objectives To examine the safety and efficacy of pharmacological VTE prophylaxis i...
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| Veröffentlicht in: | Journal of thrombosis and haemostasis 2015-07, Vol.13 (7), p.1245-1253 |
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| creator | Shatzel, J. Dulai, P. S. Harbin, D. Cheung, H. Reid, T. N. Kim, J. James, S. L. Khine, H. Batman, S. Whyman, J. Dickson, R. C. Ornstein, D. L. |
| description | Summary
Background
Hospitalized patients with cirrhosis are at increased risk for venous thromboembolism (VTE). The benefits and risks of pharmacological thromboprohylaxis in these patients have not been well studied.
Objectives
To examine the safety and efficacy of pharmacological VTE prophylaxis in hospitalized cirrhotic patients.
Patients/Methods
Retrospective cohort study of patients with cirrhosis hospitalized at an academic tertiary care referral center over a 5‐year period.
Results
Six hundred hospital admissions accounting for 402 patients were included. VTE prophylaxis was administered during 296 (49%) admissions. Patients receiving VTE prophylaxis were older (59 years vs. 55 years, P |
| doi_str_mv | 10.1111/jth.13000 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_6658183</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>3735160971</sourcerecordid><originalsourceid>FETCH-LOGICAL-c5130-21414b2e1a54a896b360fcb1e065bbcfc97efeb5c1071cdcbe668dc24c49a4ea3</originalsourceid><addsrcrecordid>eNp1kcFu1DAQhi0EoqVw4AWQJU4ctrXj2Ek4IKEKKKgSB8rZsifjjVfZONjelnDiEfqMPAku21ZwwBdbM5__-Uc_Ic85O-blnGzycMwFY-wBOeRStKumFerh3bsT4oA8SWnDGO9kxR6Tg0p2UrKmOyTXX4zDvFAz9RSd82BgocHReTBxayCMYV1qI81DDFsb5hjmYRnNd5-oC5EOIc0-m9H_wJ7OJnuccqJXPg8UfIyl7dNramjy03rEXz-voQAYacQcy1eE7C-RQhhCzDTlXb88JY-cGRM-u72PyNf37y5Oz1bnnz98PH17vgJZVl1VvOa1rZAbWZu2U1Yo5sByZEpaCw66Bh1aCZw1HHqwqFTbQ1VD3ZkajTgib_a6885usb_xFc2o5-i3Ji46GK__7Ux-0OtwqZWSLW9FEXh5KxDDtx2mrDdhF6fiWXPViUaoquGFerWnoOybIrr7CZzpm_B0CU__Ca-wL_62dE_epVWAkz1w5Udc_q-kP12c7SV_Awgdqx4</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1693736271</pqid></control><display><type>article</type><title>Safety and efficacy of pharmacological thromboprophylaxis for hospitalized patients with cirrhosis: a single‐center retrospective cohort study</title><source>MEDLINE</source><source>Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals</source><source>Alma/SFX Local Collection</source><creator>Shatzel, J. ; Dulai, P. S. ; Harbin, D. ; Cheung, H. ; Reid, T. N. ; Kim, J. ; James, S. L. ; Khine, H. ; Batman, S. ; Whyman, J. ; Dickson, R. C. ; Ornstein, D. L.</creator><creatorcontrib>Shatzel, J. ; Dulai, P. S. ; Harbin, D. ; Cheung, H. ; Reid, T. N. ; Kim, J. ; James, S. L. ; Khine, H. ; Batman, S. ; Whyman, J. ; Dickson, R. C. ; Ornstein, D. L.</creatorcontrib><description>Summary
Background
Hospitalized patients with cirrhosis are at increased risk for venous thromboembolism (VTE). The benefits and risks of pharmacological thromboprohylaxis in these patients have not been well studied.
Objectives
To examine the safety and efficacy of pharmacological VTE prophylaxis in hospitalized cirrhotic patients.
Patients/Methods
Retrospective cohort study of patients with cirrhosis hospitalized at an academic tertiary care referral center over a 5‐year period.
Results
Six hundred hospital admissions accounting for 402 patients were included. VTE prophylaxis was administered during 296 (49%) admissions. Patients receiving VTE prophylaxis were older (59 years vs. 55 years, P < 0.001), had longer lengths of stay (9.6 days vs. 6.8 days, P = 0.002), and lower Model for End‐Stage Liver Disease scores (13.2 vs. 16.1, P < 0.001). In‐hospital bleeding events (8.1% vs. 5.5%, P = 0.258), gastrointestinal bleeding events (3.0% vs. 3.2% P = 0.52), new VTE events (2.37% vs. 1.65%, P = 0.537), and mortality (8.4% vs. 7.3%, P = 0.599) were similar in the two groups. VTE prophylaxis did not reduce the risk of VTE (odds ratio 0.94, 95% confidence interval 0.23–3.71), and patients receiving unfractionated heparin, but not low molecular weight heparin, were at increased risk for in‐hospital bleeding events (odds ratio 2.38, 95% confidence interval 1.15–4.94 vs. 0.87, 0.37–2.05, respectively).
Conclusion
The rate of VTE in this cohort of hospitalized cirrhotic patients was low and was unaffected by pharmacological thromboprophylaxis. Unfractionated heparin was associated with an increased risk for in‐hospital bleeding, suggesting that if thromboprophylaxis is indicated, low molecular weight heparin may be favored.</description><identifier>ISSN: 1538-7933</identifier><identifier>ISSN: 1538-7836</identifier><identifier>EISSN: 1538-7836</identifier><identifier>DOI: 10.1111/jth.13000</identifier><identifier>PMID: 25955079</identifier><language>eng</language><publisher>England: Elsevier Limited</publisher><subject>Academic Medical Centers ; Aged ; Anticoagulants - administration & dosage ; Anticoagulants - adverse effects ; cirrhosis ; Drug Administration Schedule ; Female ; Gastrointestinal Hemorrhage - chemically induced ; Heparin, Low-Molecular-Weight - administration & dosage ; Hospitalization ; Humans ; Length of Stay ; Liver Cirrhosis - complications ; Liver Cirrhosis - diagnosis ; Liver Cirrhosis - drug therapy ; low molecular weight heparin ; Male ; Middle Aged ; New Hampshire ; Odds Ratio ; prophylaxis ; Retrospective Studies ; Risk Factors ; Tertiary Care Centers ; Time Factors ; Treatment Outcome ; unfractionated heparin ; venous thromboembolism ; Venous Thromboembolism - diagnosis ; Venous Thromboembolism - etiology ; Venous Thromboembolism - prevention & control</subject><ispartof>Journal of thrombosis and haemostasis, 2015-07, Vol.13 (7), p.1245-1253</ispartof><rights>2015 International Society on Thrombosis and Haemostasis</rights><rights>2015 International Society on Thrombosis and Haemostasis.</rights><rights>Copyright © 2015 International Society on Thrombosis and Haemostasis</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c5130-21414b2e1a54a896b360fcb1e065bbcfc97efeb5c1071cdcbe668dc24c49a4ea3</citedby><cites>FETCH-LOGICAL-c5130-21414b2e1a54a896b360fcb1e065bbcfc97efeb5c1071cdcbe668dc24c49a4ea3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,777,781,882,27905,27906</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25955079$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Shatzel, J.</creatorcontrib><creatorcontrib>Dulai, P. S.</creatorcontrib><creatorcontrib>Harbin, D.</creatorcontrib><creatorcontrib>Cheung, H.</creatorcontrib><creatorcontrib>Reid, T. N.</creatorcontrib><creatorcontrib>Kim, J.</creatorcontrib><creatorcontrib>James, S. L.</creatorcontrib><creatorcontrib>Khine, H.</creatorcontrib><creatorcontrib>Batman, S.</creatorcontrib><creatorcontrib>Whyman, J.</creatorcontrib><creatorcontrib>Dickson, R. C.</creatorcontrib><creatorcontrib>Ornstein, D. L.</creatorcontrib><title>Safety and efficacy of pharmacological thromboprophylaxis for hospitalized patients with cirrhosis: a single‐center retrospective cohort study</title><title>Journal of thrombosis and haemostasis</title><addtitle>J Thromb Haemost</addtitle><description>Summary
Background
Hospitalized patients with cirrhosis are at increased risk for venous thromboembolism (VTE). The benefits and risks of pharmacological thromboprohylaxis in these patients have not been well studied.
Objectives
To examine the safety and efficacy of pharmacological VTE prophylaxis in hospitalized cirrhotic patients.
Patients/Methods
Retrospective cohort study of patients with cirrhosis hospitalized at an academic tertiary care referral center over a 5‐year period.
Results
Six hundred hospital admissions accounting for 402 patients were included. VTE prophylaxis was administered during 296 (49%) admissions. Patients receiving VTE prophylaxis were older (59 years vs. 55 years, P < 0.001), had longer lengths of stay (9.6 days vs. 6.8 days, P = 0.002), and lower Model for End‐Stage Liver Disease scores (13.2 vs. 16.1, P < 0.001). In‐hospital bleeding events (8.1% vs. 5.5%, P = 0.258), gastrointestinal bleeding events (3.0% vs. 3.2% P = 0.52), new VTE events (2.37% vs. 1.65%, P = 0.537), and mortality (8.4% vs. 7.3%, P = 0.599) were similar in the two groups. VTE prophylaxis did not reduce the risk of VTE (odds ratio 0.94, 95% confidence interval 0.23–3.71), and patients receiving unfractionated heparin, but not low molecular weight heparin, were at increased risk for in‐hospital bleeding events (odds ratio 2.38, 95% confidence interval 1.15–4.94 vs. 0.87, 0.37–2.05, respectively).
Conclusion
The rate of VTE in this cohort of hospitalized cirrhotic patients was low and was unaffected by pharmacological thromboprophylaxis. Unfractionated heparin was associated with an increased risk for in‐hospital bleeding, suggesting that if thromboprophylaxis is indicated, low molecular weight heparin may be favored.</description><subject>Academic Medical Centers</subject><subject>Aged</subject><subject>Anticoagulants - administration & dosage</subject><subject>Anticoagulants - adverse effects</subject><subject>cirrhosis</subject><subject>Drug Administration Schedule</subject><subject>Female</subject><subject>Gastrointestinal Hemorrhage - chemically induced</subject><subject>Heparin, Low-Molecular-Weight - administration & dosage</subject><subject>Hospitalization</subject><subject>Humans</subject><subject>Length of Stay</subject><subject>Liver Cirrhosis - complications</subject><subject>Liver Cirrhosis - diagnosis</subject><subject>Liver Cirrhosis - drug therapy</subject><subject>low molecular weight heparin</subject><subject>Male</subject><subject>Middle Aged</subject><subject>New Hampshire</subject><subject>Odds Ratio</subject><subject>prophylaxis</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>Tertiary Care Centers</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><subject>unfractionated heparin</subject><subject>venous thromboembolism</subject><subject>Venous Thromboembolism - diagnosis</subject><subject>Venous Thromboembolism - etiology</subject><subject>Venous Thromboembolism - prevention & control</subject><issn>1538-7933</issn><issn>1538-7836</issn><issn>1538-7836</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kcFu1DAQhi0EoqVw4AWQJU4ctrXj2Ek4IKEKKKgSB8rZsifjjVfZONjelnDiEfqMPAku21ZwwBdbM5__-Uc_Ic85O-blnGzycMwFY-wBOeRStKumFerh3bsT4oA8SWnDGO9kxR6Tg0p2UrKmOyTXX4zDvFAz9RSd82BgocHReTBxayCMYV1qI81DDFsb5hjmYRnNd5-oC5EOIc0-m9H_wJ7OJnuccqJXPg8UfIyl7dNramjy03rEXz-voQAYacQcy1eE7C-RQhhCzDTlXb88JY-cGRM-u72PyNf37y5Oz1bnnz98PH17vgJZVl1VvOa1rZAbWZu2U1Yo5sByZEpaCw66Bh1aCZw1HHqwqFTbQ1VD3ZkajTgib_a6885usb_xFc2o5-i3Ji46GK__7Ux-0OtwqZWSLW9FEXh5KxDDtx2mrDdhF6fiWXPViUaoquGFerWnoOybIrr7CZzpm_B0CU__Ca-wL_62dE_epVWAkz1w5Udc_q-kP12c7SV_Awgdqx4</recordid><startdate>201507</startdate><enddate>201507</enddate><creator>Shatzel, J.</creator><creator>Dulai, P. S.</creator><creator>Harbin, D.</creator><creator>Cheung, H.</creator><creator>Reid, T. N.</creator><creator>Kim, J.</creator><creator>James, S. L.</creator><creator>Khine, H.</creator><creator>Batman, S.</creator><creator>Whyman, J.</creator><creator>Dickson, R. C.</creator><creator>Ornstein, D. L.</creator><general>Elsevier Limited</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>H94</scope><scope>K9.</scope><scope>5PM</scope></search><sort><creationdate>201507</creationdate><title>Safety and efficacy of pharmacological thromboprophylaxis for hospitalized patients with cirrhosis: a single‐center retrospective cohort study</title><author>Shatzel, J. ; Dulai, P. S. ; Harbin, D. ; Cheung, H. ; Reid, T. N. ; Kim, J. ; James, S. L. ; Khine, H. ; Batman, S. ; Whyman, J. ; Dickson, R. C. ; Ornstein, D. L.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c5130-21414b2e1a54a896b360fcb1e065bbcfc97efeb5c1071cdcbe668dc24c49a4ea3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Academic Medical Centers</topic><topic>Aged</topic><topic>Anticoagulants - administration & dosage</topic><topic>Anticoagulants - adverse effects</topic><topic>cirrhosis</topic><topic>Drug Administration Schedule</topic><topic>Female</topic><topic>Gastrointestinal Hemorrhage - chemically induced</topic><topic>Heparin, Low-Molecular-Weight - administration & dosage</topic><topic>Hospitalization</topic><topic>Humans</topic><topic>Length of Stay</topic><topic>Liver Cirrhosis - complications</topic><topic>Liver Cirrhosis - diagnosis</topic><topic>Liver Cirrhosis - drug therapy</topic><topic>low molecular weight heparin</topic><topic>Male</topic><topic>Middle Aged</topic><topic>New Hampshire</topic><topic>Odds Ratio</topic><topic>prophylaxis</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><topic>Tertiary Care Centers</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><topic>unfractionated heparin</topic><topic>venous thromboembolism</topic><topic>Venous Thromboembolism - diagnosis</topic><topic>Venous Thromboembolism - etiology</topic><topic>Venous Thromboembolism - prevention & control</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Shatzel, J.</creatorcontrib><creatorcontrib>Dulai, P. S.</creatorcontrib><creatorcontrib>Harbin, D.</creatorcontrib><creatorcontrib>Cheung, H.</creatorcontrib><creatorcontrib>Reid, T. N.</creatorcontrib><creatorcontrib>Kim, J.</creatorcontrib><creatorcontrib>James, S. L.</creatorcontrib><creatorcontrib>Khine, H.</creatorcontrib><creatorcontrib>Batman, S.</creatorcontrib><creatorcontrib>Whyman, J.</creatorcontrib><creatorcontrib>Dickson, R. C.</creatorcontrib><creatorcontrib>Ornstein, D. L.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Journal of thrombosis and haemostasis</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Shatzel, J.</au><au>Dulai, P. S.</au><au>Harbin, D.</au><au>Cheung, H.</au><au>Reid, T. N.</au><au>Kim, J.</au><au>James, S. L.</au><au>Khine, H.</au><au>Batman, S.</au><au>Whyman, J.</au><au>Dickson, R. C.</au><au>Ornstein, D. L.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Safety and efficacy of pharmacological thromboprophylaxis for hospitalized patients with cirrhosis: a single‐center retrospective cohort study</atitle><jtitle>Journal of thrombosis and haemostasis</jtitle><addtitle>J Thromb Haemost</addtitle><date>2015-07</date><risdate>2015</risdate><volume>13</volume><issue>7</issue><spage>1245</spage><epage>1253</epage><pages>1245-1253</pages><issn>1538-7933</issn><issn>1538-7836</issn><eissn>1538-7836</eissn><abstract>Summary
Background
Hospitalized patients with cirrhosis are at increased risk for venous thromboembolism (VTE). The benefits and risks of pharmacological thromboprohylaxis in these patients have not been well studied.
Objectives
To examine the safety and efficacy of pharmacological VTE prophylaxis in hospitalized cirrhotic patients.
Patients/Methods
Retrospective cohort study of patients with cirrhosis hospitalized at an academic tertiary care referral center over a 5‐year period.
Results
Six hundred hospital admissions accounting for 402 patients were included. VTE prophylaxis was administered during 296 (49%) admissions. Patients receiving VTE prophylaxis were older (59 years vs. 55 years, P < 0.001), had longer lengths of stay (9.6 days vs. 6.8 days, P = 0.002), and lower Model for End‐Stage Liver Disease scores (13.2 vs. 16.1, P < 0.001). In‐hospital bleeding events (8.1% vs. 5.5%, P = 0.258), gastrointestinal bleeding events (3.0% vs. 3.2% P = 0.52), new VTE events (2.37% vs. 1.65%, P = 0.537), and mortality (8.4% vs. 7.3%, P = 0.599) were similar in the two groups. VTE prophylaxis did not reduce the risk of VTE (odds ratio 0.94, 95% confidence interval 0.23–3.71), and patients receiving unfractionated heparin, but not low molecular weight heparin, were at increased risk for in‐hospital bleeding events (odds ratio 2.38, 95% confidence interval 1.15–4.94 vs. 0.87, 0.37–2.05, respectively).
Conclusion
The rate of VTE in this cohort of hospitalized cirrhotic patients was low and was unaffected by pharmacological thromboprophylaxis. Unfractionated heparin was associated with an increased risk for in‐hospital bleeding, suggesting that if thromboprophylaxis is indicated, low molecular weight heparin may be favored.</abstract><cop>England</cop><pub>Elsevier Limited</pub><pmid>25955079</pmid><doi>10.1111/jth.13000</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
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| identifier | ISSN: 1538-7933 |
| ispartof | Journal of thrombosis and haemostasis, 2015-07, Vol.13 (7), p.1245-1253 |
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| source | MEDLINE; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Alma/SFX Local Collection |
| subjects | Academic Medical Centers Aged Anticoagulants - administration & dosage Anticoagulants - adverse effects cirrhosis Drug Administration Schedule Female Gastrointestinal Hemorrhage - chemically induced Heparin, Low-Molecular-Weight - administration & dosage Hospitalization Humans Length of Stay Liver Cirrhosis - complications Liver Cirrhosis - diagnosis Liver Cirrhosis - drug therapy low molecular weight heparin Male Middle Aged New Hampshire Odds Ratio prophylaxis Retrospective Studies Risk Factors Tertiary Care Centers Time Factors Treatment Outcome unfractionated heparin venous thromboembolism Venous Thromboembolism - diagnosis Venous Thromboembolism - etiology Venous Thromboembolism - prevention & control |
| title | Safety and efficacy of pharmacological thromboprophylaxis for hospitalized patients with cirrhosis: a single‐center retrospective cohort study |
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