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Thrombosis  2013 

Venous Thromboembolism in Critically Ill Cirrhotic Patients: Practices of Prophylaxis and Incidence

DOI: 10.1155/2013/807526

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Objectives. We compared venous thromboembolism (VTE) prophylaxis practices and incidence in critically ill cirrhotic versus noncirrhotic patients and evaluated cirrhosis as a VTE risk factor. Methods. A cohort of 798 critically ill patients followed for the development of clinically detected VTE were categorized according to the diagnosis of cirrhosis. VTE prophylaxis practices and incidence were compared. Results. Seventy-five (9.4%) patients had cirrhosis with significantly higher INR (2.2 ± 0.9 versus 1.3 ± 0.6, ), lower platelet counts (115,000 ± 90,000 versus 258,000 ± 155,000/μL, ), and higher creatinine compared to noncirrhotic patients. Among cirrhotics, 31 patients received only mechanical prophylaxis, 24 received pharmacologic prophylaxis, and 20 did not have any prophylaxis. Cirrhotic patients were less likely to receive pharmacologic prophylaxis (odds ratio, 0.08; 95% confidence interval (CI), 0.04–0.14). VTE occurred in only two (2.7%) cirrhotic patients compared to 7.6% in noncirrhotic patients ( ). The incidence rate was 2.2 events per 1000 patient-ICU days for cirrhotic patients and 3.6 events per 1000 patient-ICU days for noncirrhotics (incidence rate ratio, 0.61; 95% CI, 0.15–2.52). On multivariate Cox regression analysis, cirrhosis was not associated with VTE risk (hazard ratio, 0.40; 95% CI, 0.10–1.67). Conclusions. In critically ill cirrhotic patients, VTE incidence did not statistically differ from that in noncirrhotic patients. 1. Background Chronic liver disease leads to decreased synthesis of coagulation proteins, such as factors II, VII, IX, and X, and is frequently associated with thrombocytopenia [1–3]. Whether these abnormalities make cirrhotic patients less prone to venous thromboembolism (VTE) than the general population is unclear, especially given that cirrhosis is also associated with decreased production of anticoagulation factors, such as protein C, protein S, and antithrombin III [2, 3]. A population-based, case-control study found that liver disease was associated with reduced VTE risk (odds ratio (OR), 0.1; 95% CI, 0.0–0.7) [4]. One retrospective case-control study in hospitalized cirrhotic patients found that VTE occurred in only 0.5% of patients [5], a rate that was lower than that reported in general medical patients [5]. However, more recent studies found higher VTE rates in hospitalized cirrhotic patients (2.7–6.3%) [6, 7]. Additionally, a study of 963 cirrhotic patients and 12,405 controls admitted to a tertiary care hospital found that cirrhotics had higher (1.8%) VTE incidence than controls in general

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