Study shows need for more education on VTE prophylaxis in cirrhosis

The administration of VTE prophylaxis appears to be suboptimal in patients with cirrhosis – possibly due to confusion about the relative risks of thrombotic events and bleeding.

The retrospective study of 108 patients with cirrhosis at the University Hospital Geelong found only 56.5% received enoxaparin for VTE prophylaxis according to hospital guidelines.

Yet in a control group of patients without cirrhosis, 96.3% received VTE chemoprophylaxis as recommended.

Patients with cirrhosis who did not receive VTE prophylaxis were more likely to have lower platelet counts and a higher INR than patients who were given prophylaxis.

The study authors said there was increasing evidence that patients with cirrhosis were not naturally auto-anticoagulated and were at increased risk of both portal and systemic thrombosis.

“Cirrhosis has traditionally been perceived as an acquired bleeding disorder,” they said.

“However, this concept has been replaced by a new consensus that the coagulation system in cirrhosis is rebalanced with parallel reduction in both pro- and anticoagulant factors,”

“Our results suggest that in cirrhotic patients, platelet count and INR are parameters that influence clinicians’ decisions regarding use of VTE prophylaxis.”

In addition, the reasons for withholding VTE chemoprophylaxis in patients without contraindications were rarely documented, the study found.

Co-author and gastroenterology trainee Dr Linda Yang told the limbic that education was clearly required about the risk of VTE and the fact that prophylaxis should be considered.

“If people were considering it, then they would be documenting why they are not giving it.”

She said thromboelastometry had been suggested as a more accurate way to provide a global overview of coagulation in patients with cirrhosis.

However the point-of-care tests such as Haemoview’s ROTEM (Rotational Thromboelastometry) and Haemonetics’ TEG (Thrombelastograph) were not yet widely available.

“It could be useful in checking the coagulation profile of the cirrhotic patients more accurately and then deciding their bleeding risk and when to withhold or when to give prophylaxis,” Dr Yang said.

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