MSPH, Division of Pulmonary, Critical Care, and Environmental Medicine, University of Missouri-Columbia, 5 Hospital Dr, CE428 CS&E Bldg, Columbia, MO 65212, USA.
Chest. 2010 May;137(5):1145-9. doi: 10.1378/chest.09-2177. Epub 2009 Dec 29.
It is uncertain whether pathologically prolonged international normalized ratio (INR) seen in chronic liver disease (CLD) protects against venous thromboembolism (VTE). Previous studies reported VTE incidence of 0.5% to 1.9% in patients with CLD. We sought to evaluate VTE incidence among hospitalized patients with CLD according to INR levels.
This was a retrospective cohort study performed at a tertiary university hospital. We included all adult patients admitted with a primary diagnosis of CLD over a 7-year period. The primary outcome was the development of VTE during hospital stay. Patients were divided into quartiles according to their highest admission INR. VTE events and prophylaxis rates were compared among INR quartiles.
During the allotted 7-year period, we included 190 patients. Of these, 12 developed VTE events, yielding a VTE incidence of 6.3%. There was no significant difference in the incidence of VTE between INR quartiles. Hospital mortality rates were higher in the higher INR quartiles than in the lower ones (P < .001), but hospital length of stay was not significantly different. Of the patients with documented VTE, one (4.2%) was Child-Pugh stage A, three (4.6%) were stage B, and eight (8.0%) were stage C (P = .602). VTE prophylaxis was not used in 75% of patients.
An elevated INR in the setting of CLD does not appear to protect against the development of hospital-acquired VTE. The notion that "auto-anticoagulation" protects against VTE is unfounded. Use of DVT prophylaxis was extremely low in this population.
慢性肝脏疾病（CLD）患者的国际标准化比值（INR）延长是否能预防静脉血栓栓塞症（VTE）尚不确定。此前的研究报道，CLD 患者的 VTE 发生率为 0.5%至 1.9%。我们旨在评估根据 INR 水平住院 CLD 患者的 VTE 发生率。
这是一项在三级大学医院进行的回顾性队列研究。我们纳入了在 7 年期间内因原发性 CLD 入院的所有成年患者。主要结局是住院期间发生 VTE。患者根据最高入院 INR 分为 quartiles。比较了 INR quartiles 之间的 VTE 事件和预防治疗率。
在规定的 7 年期间，我们纳入了 190 例患者。其中，12 例发生了 VTE 事件，VTE 发生率为 6.3%。INR quartiles 之间的 VTE 发生率无显著差异。较高 INR quartiles 的住院死亡率高于较低 quartiles（P<.001），但住院时间无显著差异。有记录的 VTE 患者中，1 例（4.2%）为 Child-Pugh 分级 A，3 例（4.6%）为分级 B，8 例（8.0%）为分级 C（P=.602）。75%的患者未使用 VTE 预防治疗。
CLD 患者 INR 升高似乎并不能预防医院获得性 VTE 的发生。“自身抗凝”可预防 VTE 的观点是没有依据的。该人群中 DVT 预防治疗的使用率极低。
