Gastroenterol Res

Gastroenterology Research, ISSN 1918-2805 print, 1918-2813 online, Open Access

Article copyright, the authors; Journal compilation copyright, Gastroenterol Res and Elmer Press Inc

Journal website https://www.gastrores.org

Original Article

Volume 15, Number 2, April 2022, pages 67-74

The Incidence of Venous Thromboembolism and Practice of Deep Venous Thrombosis Prophylaxis Among Hospitalized Cirrhotic Patients

**Table 1.** Baseline Characteristics of Included Patients With Liver Cirrhosis
Characteristic	Pharmacologic VTE, prophylaxis percentage (n = 289)	Non-pharmacologic VTE, prophylaxis percentage (n = 312)	P value
VTE: venous thromboembolism; PBC: primary biliary cirrhosis; PSC: primary sclerosing cholangitis.
Median age	65.62	61.42	0.001
Male gender	56.7% (164)	66.7% (208)	0.012
Race			0.11
White	54.7% (158)	59.6% (186)
African American	12.1% (35)	7.4% (23)
Asian	3.1% (9)	1.3% (4)
Other/unavailable	30.1% (87)	31.7% (99)
Body mass index (kg/m²)	28.0387	27.4424	0.328
Alcohol	34.6% (100)	47.1% (147)	0.02
Tobacco	11.1% (32)	9.9% (31)	0.649
Coronary artery disease	21.1% (61)	11.3% (35)	0.001
Heart failure	22.1% (64)	11.2% (35)	0.001
Chronic kidney disease	13.8% (40)	10.9% (34)	0.273
End-stage renal disease	7.3% (21)	3.5% (11)	0.041
Diabetes mellitus	37.7% (109)	29.8% (93)	0.04
Hypertension	61.6% (178)	44.9% (140)	0.001
Surgical procedure during admission	11.5% (33)	10.3% (32)	0.636
Surgical procedure 6 months before admission	9.3% (27)	11.9% (37)	0.304
Infection	34.3% (99)	24.4% (76)	0.008
Intensive care unit stay	12.8% (37)	10.6% (33)	0.395
Etiology of liver cirrhosis
Nonalcoholic steatohepatitis	12.1% (35)	10.6% (33)	0.563
Alcohol	34.9% (101)	45.5% (142)	0.008
Hepatitis C	21.5% (62)	20.8% (65)	0.852
Other			0.001
Hepatitis B	4.8% (14)	5.4% (17)
Hemochromatosis	1.4% (4)	1% (3)
Autoimmune	1% (3)	2.2% (7)
PBC	2.8% (8)	2.6% (8)
PSC	0.34 (1)	0.64% (2)
Cryptogenic	7.6% (22)	8% (25)
Other	13.56% (40)	3.26% (10)
Esophageal varices	9.8% (28)	31% (95)	0.001
Labs on admission
Hemoglobin	11.88	10.71	0.001
Platelets count	172.03	119	0.001
INR	1.33	1.53	< 0.001
Creatinine	1.57	1.29	0.026
Albumin	3.11	2.93	0.003
Sodium	136.77	137.46	0.131
Bilirubin	1.96	2.84	0.003
Ascites present on admission	34.9% (101)	46.9% (146)	0.003
Hepatic encephalopathy	16.3% (47)	24.4% (76)	0.014
Child-Pugh score	7.24	7.92	0.507
Mean MELD-Na	12.61	13.39	> 0.05

Table 1. Baseline Characteristics of Included Patients With Liver Cirrhosis

Characteristic

Pharmacologic VTE, prophylaxis percentage (n = 289)

Non-pharmacologic VTE, prophylaxis percentage (n = 312)

P value

VTE: venous thromboembolism; PBC: primary biliary cirrhosis; PSC: primary sclerosing cholangitis.

Median age

65.62

61.42

0.001

Male gender

56.7% (164)

66.7% (208)

0.012

Race

0.11

White

54.7% (158)

59.6% (186)

African American

12.1% (35)

7.4% (23)

Asian

3.1% (9)

1.3% (4)

Other/unavailable

30.1% (87)

31.7% (99)

Body mass index (kg/m²)

28.0387

27.4424

0.328

Alcohol

34.6% (100)

47.1% (147)

0.02

Tobacco

11.1% (32)

9.9% (31)

0.649

Coronary artery disease

21.1% (61)

11.3% (35)

0.001

Heart failure

22.1% (64)

11.2% (35)

0.001

Chronic kidney disease

13.8% (40)

10.9% (34)

0.273

End-stage renal disease

7.3% (21)

3.5% (11)

0.041

Diabetes mellitus

37.7% (109)

29.8% (93)

0.04

Hypertension

61.6% (178)

44.9% (140)

0.001

Surgical procedure during admission

11.5% (33)

10.3% (32)

0.636

Surgical procedure 6 months before admission

9.3% (27)

11.9% (37)

0.304

Infection

34.3% (99)

24.4% (76)

0.008

Intensive care unit stay

12.8% (37)

10.6% (33)

0.395

Etiology of liver cirrhosis

Nonalcoholic steatohepatitis

12.1% (35)

10.6% (33)

0.563

Alcohol

34.9% (101)

45.5% (142)

0.008

Hepatitis C

21.5% (62)

20.8% (65)

0.852

Other

0.001

Hepatitis B

4.8% (14)

5.4% (17)

Hemochromatosis

1.4% (4)

1% (3)

Autoimmune

1% (3)

2.2% (7)

PBC

2.8% (8)

2.6% (8)

PSC

0.34 (1)

0.64% (2)

Cryptogenic

7.6% (22)

8% (25)

Other

13.56% (40)

3.26% (10)

Esophageal varices

9.8% (28)

31% (95)

0.001

Labs on admission

Hemoglobin

11.88

10.71

0.001

Platelets count

172.03

119

0.001

INR

1.33

1.53

< 0.001

Creatinine

1.57

1.29

0.026

Albumin

3.11

2.93

0.003

Sodium

136.77

137.46

0.131

Bilirubin

1.96

2.84

0.003

Ascites present on admission

34.9% (101)

46.9% (146)

0.003

Hepatic encephalopathy

16.3% (47)

24.4% (76)

0.014

Child-Pugh score

7.24

7.92

0.507

Mean MELD-Na

12.61

13.39

> 0.05

**Table 2.** The Impact of VTE Prophylaxis on the Incidence of VTE and Outcomes Among Subgroups of Hospitalized Cirrhotic Patients
	Pharmacologic VTE prophylaxis (n = 289)	No pharmacologic VTE prophylaxis (n = 312)	P value
VTE: venous thromboembolism.
Primary outcome
Total VTE	0.7% (2)	2.2% (7)	0.118
VTE during admission	0.35% (1)	1% (3)	0.354
Secondary outcomes
Bleeding	2.8% (8)	20.2% (63)	< 0.001
Transfusion	12.5% (36)	31.1% (97)	< 0.001
Hospital length of stay	7.55	6.66	0.118
6-month readmission	38.8% (112)	35.6% (111)	0.420

Table 2. The Impact of VTE Prophylaxis on the Incidence of VTE and Outcomes Among Subgroups of Hospitalized Cirrhotic Patients

Pharmacologic VTE prophylaxis (n = 289)

No pharmacologic VTE prophylaxis (n = 312)

P value

VTE: venous thromboembolism.

Primary outcome

Total VTE

0.7% (2)

2.2% (7)

0.118

VTE during admission

0.35% (1)

1% (3)

0.354

Secondary outcomes

Bleeding

2.8% (8)

20.2% (63)

< 0.001

Transfusion

12.5% (36)

31.1% (97)

< 0.001

Hospital length of stay

7.55

6.66

0.118

6-month readmission

38.8% (112)

35.6% (111)

0.420

**Table 3.** List of Hospitalized Cirrhotic Patients With Newly Diagnosed VTE: Risk Factors, Diagnostic Modality, Location, and Days to Diagnosis
Cases	VTE prophylaxis	Location	Modality of diagnosis	Days to VTE from admission	Treatment/intervention	Age	Gender	Platelet	Albumin	INR
^aApixaban was tried and was complicated by bleeding. VTE: venous thromboembolism; SCD: sequential compression device; IV: intravenous; SC: subcutaneous; PE: pulmonary embolism; CT: computed tomography; LMWH: low-molecular-weight heparin; F: female; M: male; INR: international normalized ratio.
1	SCD	Right brachial vein	Ultrasound duplex	10	None	70	F	51	2.7	1.36
2	SCD	Right common femoral	Ultrasound duplex	4	None	92	M	77	3	1.43
3	SCD	Left popliteal and left lower lobe PE	CT angiography and ultrasound duplex	7	IV heparin then Coumadin	66	F	72	2.3	3.42
4	SCD	Left portal vein	CT scan with IV contrast	5	None	61	M	38	2.3	1.42
5	None	Right common femoral vein	Ultrasound duplex	4	Inferior vena cava filter	76	M	121	3	1.46
6	None	Left common femoral vein	Ultrasound duplex	33	Inferior vena cava filter^a	88	F	373	2.7	0.94
7	None	Left iliac vein	Ultrasound duplex	2	Patient refused treatment	59	F	144	3.1	1.05
8	Heparin SC	Left femoral and popliteal veins	Ultrasound duplex	21	LMWH SC	37	M	285	1.6	1.74
9	Heparin SC	Left subclavian vein	Ultrasound duplex	30	Rivaroxaban	61	M	146	2.2	1.28

Table 3. List of Hospitalized Cirrhotic Patients With Newly Diagnosed VTE: Risk Factors, Diagnostic Modality, Location, and Days to Diagnosis

Cases

VTE prophylaxis

Location

Modality of diagnosis

Days to VTE from admission

Treatment/intervention

Age

Gender

Platelet

Albumin

INR

^aApixaban was tried and was complicated by bleeding. VTE: venous thromboembolism; SCD: sequential compression device; IV: intravenous; SC: subcutaneous; PE: pulmonary embolism; CT: computed tomography; LMWH: low-molecular-weight heparin; F: female; M: male; INR: international normalized ratio.

SCD

Right brachial vein

Ultrasound duplex

None

2.7

1.36

SCD

Right common femoral

Ultrasound duplex

None

1.43

SCD

Left popliteal and left lower lobe PE

CT angiography and ultrasound duplex

IV heparin then Coumadin

2.3

3.42

SCD

Left portal vein

CT scan with IV contrast

None

2.3

1.42

None

Right common femoral vein

Ultrasound duplex

Inferior vena cava filter

121

1.46

None

Left common femoral vein

Ultrasound duplex

Inferior vena cava filter^a

373

2.7

0.94

None

Left iliac vein

Ultrasound duplex

Patient refused treatment

144

3.1

1.05

Heparin SC

Left femoral and popliteal veins

Ultrasound duplex

LMWH SC

285

1.6

1.74

Heparin SC

Left subclavian vein

Ultrasound duplex

Rivaroxaban

146

2.2

1.28