Division of Gastroenterology and Hepatology, University of Virginia, Charlottesville, VA, USA.
Eur J Haematol. 2020 Mar;104(3):223-229. doi: 10.1111/ejh.13363. Epub 2020 Jan 19.
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.
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.
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.
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.
患有肝脏疾病的患者存在静脉血栓栓塞（VTE）的风险；然而，对于肝硬化患者中 VTE 预防的安全性和有效性知之甚少。我们研究了在一个住院肝病患者的封闭队列中，应用 VTE 风险评估模型来指导 VTE 预防决策。
连续评估了一家三级护理中心的住院肝病服务中需要 VTE 预防的患者。将 IMPROVE 风险评估与 VTE 预防的现行实践模式进行比较。记录出血和血栓形成事件的发生率。
我们的分析包括 98 例患者就诊。76%的患者在实践中接受了 VTE 预防。IMPROVE 建议在 19%的患者中使用 VTE 预防。与根据 IMPROVE 认为需要 VTE 预防的患者相比，接受不必要的 VTE 预防的患者发生血栓形成的风险显著降低。
应用 IMPROVE 风险评估将显著减少住院肝病患者中 VTE 预防的使用。我们的发现对目前所有患者都采用 VTE 预防的“一刀切”实践模式提出了挑战。需要在包括出血和血栓形成风险的临床结局在内的大型住院肝病患者队列中进行进一步研究。
