Overuse of venous thromboembolism prophylaxis among hospitalized patients with liver disease

• Published in: European journal of haematology 2020-03, Vol.104 (3), p.223-229
• Main Authors: Davis, Jessica P.E., O’Leary, Kelsey E., Intagliata, Nicolas M.
• Format: Article
• Language: English
• Subjects: Bleeding; Cirrhosis; Clotting; Decision making; hemostasis; Hospitalization; inpatients; Liver cirrhosis; Liver diseases; Prophylaxis; Risk assessment; Thromboembolism; venous thromboembolism
• ISSN: 0902-4441; 1600-0609
• DOI: 10.1111/ejh.13363

Introduction Patients with liver disease are at risk of venous thromboembolism (VTE); however, little is understood regarding the safety and efficacy of VTE prophylaxis in patients with cirrhosis. We examined the application of a VTE risk assessment model in VTE prophylaxis decision‐making in a closed cohort of hospitalized patients with liver disease. Methods Sequential patients admitted to an inpatient hepatology service at a tertiary care center were evaluated for need for VTE prophylaxis. Risk assessment by IMPROVE was compared with current practice patterns of VTE prophylaxis. Rates of bleeding and clotting events were noted. Results 98 patient encounters were included in our analysis. 76% of patients received VTE prophylaxis in practice. IMPROVE recommended use of VTE prophylaxis in 19% of patients. Patients who received VTE prophylaxis that was not warranted had significantly lower risk of clotting compared with patients in whom VTE prophylaxis was warranted per IMPROVE. Conclusions Application of IMPROVE risk assessment would significantly reduce VTE prophylaxis use among hospitalized patients with liver disease. Our findings challenge the “one‐size‐fits‐all” current practice pattern of VTE prophylaxis. Future studies are needed in large cohorts of hospitalized patients with liver disease that include clinical outcomes of bleeding and clotting risk.