Risk of Hemorrhage in Patients with Chronic Liver Disease and Coagulopathy Receiving Pharmacologic Venous Thromboembolism Prophylaxis

Study ObjectiveTo evaluate the impact of pharmacologic venous thromboembolism (VTE) prophylaxis on risk of hemorrhage while hospitalized in patients with chronic liver disease (CLD) and concurrent coagulopathy. DesignRetrospective, multicenter chart review. SettingFive hospital, university-affiliated network in eastern Pennsylvania. PatientsPatients admitted to the network from January 1, 2012, until December 31, 2012, with ICD-9 code consistent with CLD and elevated international normalized ratio of1.5 or greater not secondary to anticoagulation. Measurements and Main ResultsTwo hundred fifty-six patients met criteria for analysis, with 80 having received pharmacologic VTE prophylaxis and 176 having received no pharmacologic VTE prophylaxis. Differences were observed in the primary outcome of overall hemorrhage (composite of major and minor hemorrhage) for patients receiving VTE prophylaxis versus no VTE prophylaxis (17.5% vs 7.4%, p=0.02). Logistic regression revealed covariates independently associated with increased hemorrhage risk were pharmacologic VTE prophylaxis use (adjusted odds ratio [AOR] 3.64, p=0.004), increasing international normalized ratio (AOR 1.31, p=0.007), and decreasing platelet count (AOR 0.99, p=0.03). ConclusionsPatients with CLD and concurrent coagulopathy receiving pharmacologic VTE prophylaxis are at an increased risk of overall hemorrhage. Clinical implications remain unclear secondary to the difference in rate of overall hemorrhage being driven primarily by a difference in minor hemorrhage. In addition, no difference was demonstrated in many assessed clinically relevant markers.