Effectiveness of venous thromboembolism prophylaxis in patients with liver disease

doi:10.4254/wjh.v11.i4.379

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World Journal of Hepatology

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1948-5182

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Study

World J Hepatol. Apr 27, 2019; 11(4): 379-390
Published online Apr 27, 2019. doi: 10.4254/wjh.v11.i4.379

Table 1 Baseline characteristics

	*No prophylaxis(n =* 903)**	*Prophylaxis(n =* 903)**
Mean age (yr)	60.1 ± 11.9	60.2 ± 11.8
Male	572 (63.3)	535 (59.2)
RRT^a	221 (24.5)	267 (29.6)
CKD	226 (25.0)	238 (26.4)
Lung disease	218 (24.1)	218 (24.1)
Heart failure	192 (21.3)	196 (21.7)
MVP	291 (32.2)	286 (31.7)
VTE risk score^c
Unknown risk score	103 (11.4)	78 (8.6)
Low risk	26 (2.9)	17 (1.9)
Medium risk	591 (65.4)	680 (75.3)
High risk	183 (20.3)	128 (14.2)
BMI (kg/m²)	24.4 ± 0.20	24.4 ± 0.20
INR^c	1.4 ± 0.57	1.3 ± 0.32
Platelet count (k/µL)	144.2 ± 92.5	151.0 ± 97.0
aPTT (s)	34.8 ± 12.0	34.4 ± 10.2
Albumin (g/dL)	2.9 ± 0.70	2.9 ± 0.67
Tbili (mg/dL)	4.0 ± 7.1	3.8 ± 6.6
SCr (mg/dL)	1.5 ± 1.3 ^a	1.6 ± 1.5
Hemoglobin (g/dL)	10.4 ± 2.3 ^b	10.7 ± 2.1
Liver disease etiology
Alcoholic	278 (30.8)	286 (31.7)
NASH	27 (3.0)	22 (2.4)
Acute Hepatitis	35 (3.9)	38 (4.2)
Other¹	563 (62.3)	557 (61.7)
Mean MELD score	17.0 ± 9.1	17.4 ± 8.3
MELD category^c
MELD > 40	20 (2.2)	8 (0.89)
MELD 30-39.9	71 (7.9)	74 (8.2)
MELD 20-29.9	205 (22.7)	233 (25.8)
MELD 10-19.9	338 (37.4)	386 (42.7)
MELD < 10	269 (29.8)	202 (22.4)

Data presented as n (%) or mean ± SD.

¹Other liver disease includes primary sclerosing cholangitis, biliary cirrhosis, cirrhosis due to alpha-1 antitrypsin deficiency, and any other liver disease not included above. This categorization is for the primary hepatic International Classification of Diseases, 9^th edition (ICD-9) code for an admission; all patients had an ICD-9 code for cirrhosis.

^aP < 0.05 vs prophylaxis group;

^bP < 0.01 vs prophylaxis group;

^cP < 0.001 vs prophylaxis group. RRT: Renal replacement therapy; CKD: Chronic kidney disease; MVP: Mechanical venous thromboembolism prophylaxis; BMI: Body mass index; INR: International normalized ratio; aPTT: Activated partial thromboplastin time; Tbili: Total bilirubin; SCr: Serum creatinine; NASH: Non-alcoholic steatohepatitis; MELD: Model for end-stage liver disease.

Table 2 Matched univariate results (n = 903)

	No prophylaxis	Prophylaxis
VTE or major bleeding	79 (8.7)^a	46 (5.1)
VTE¹	17 (1.9)	20 (2.2)
Major Bleeding¹	62 (6.9) ^b	26 (2.9)
In-hospital mortality	109 (12.1)	104 (11.5)
LOS (d)	10.5 ± 12.6	10.8 ± 14.8

Data presented as n (%) or mean ± SD.

¹One patient in each group experienced both a venous thromboembolism and major bleeding event.

^aP < 0.05 vs prophylaxis group;

^bP < 0.001 vs prophylaxis group. LOS: Hospital length of stay; VTE: Venous thromboembolism.

Table 3 Multivariable analysis of risk factors for development of venous thromboembolism in patients with hepatic cirrhosis

	OR	95%CI
Prophylaxis group	0.99	0.48-2.06
BMI (kg/m²)	2.33	0.38-14.13
Baseline albumin (g/dL)	0.23	0.13-0.42
Baseline hemoglobin (g/dL)	1.18	0.99-1.41
Male sex	1.57	0.68-3.61

MELD: Model for end-stage liver disease; BMI: Body mass index.

Table 4 Multivariable analysis of risk factors for development of a major bleed in patients with hepatic cirrhosis

	OR	95%CI
Prophylaxis group	0.42	0.25-0.68
Baseline albumin (g/dL)	0.61	0.42-0.90
Baseline hemoglobin (g/dL)	0.77	0.68-0.87
BMI (kg/m²)	0.49	0.16-1.53
Male sex	0.87	0.54-1.39
MELD < 10	0.07	0.02-0.21
MELD 10-19	0.07	0.03-0.18
MELD 20-29	0.19	0.07-0.49
MELD 30-39	0.43	0.16-1.15
All MELD categories compared to MELD score > 40

MELD: Model for end-stage liver disease; BMI: Body mass index.

Table 5 Multivariable analysis of risk factors for in-hospital mortality in patients with hepatic cirrhosis

	OR	95%CI
Prophylaxis group	1.03	0.73-1.43
Baseline albumin (g/dL)	0.68	0.52-0.88
Baseline hemoglobin (g/dL)	1.00	0.92-1.08
Male sex	1.00	0.71-1.42
Occurrence of primary endpoint	2.30	1.44-3.68
MELD < 10	0.05	0.02-0.14
MELD 10-19	0.09	0.04-0.21
MELD 20-29	0.31	0.13-0.70
MELD 30-39	0.93	0.39-2.20
All MELD categories compared to MELD score > 40

MELD: Model for end-stage liver disease.

Table 6 Absolute standardized differences in baseline characteristics before and after propensity score matching

	Unmatched			Matched
	No prophylaxis	Prophylaxis	ASD	No prophylaxis	Prophylaxis	ASD
	(n = 2166)	(n = 948)	ASD	(n = 903)	(n = 903)	ASD
Age (yr)	58.1 ± 11.6	60.3 ± 11.8	0.153	60.1 ± 11.9	60.2 ± 11.8	0.00844
Male	1349 (62.3)	561(59.2)	0.0639	572 (63.3)	535 (59.2)	0.0842
RRT	819 (37.8)	270 (28.5)	0.199	221 (24.5)	267 (29.6)	0.115
CKD	577 (26.6)	247 (26.1)	0.0133	226 (25.0)	238 (26.4)	0.0304
Lung disease	397 (18.3)	236 (24.9)	0.160	218 (24.1)	218 (24.1)	0.000
Heart failure	360 (16.6)	210 (22.2)	0.140	192 (21.3)	196 (21.7)	0.0108
MVP	755 (34.9)	300 (31.6)	0.0682	291 (32.2)	286 (31.7)	0.0119
VTE risk score			0.390			0.218
Unknown	447 (20.6)	80 (8.4)		103 (11.4)	78 (8.6)
Low	86 (4.0)	17 (1.8)		26 (2.9)	17 (1.9)
Medium	1341 (61.9)	716 (75.5)		591 (65.4)	680 (75.3)
High	292 (13.5)	135 (14.2)		183 (20.3)	128 (14.2)
BMI (kg/m²)	24.2 ± 0.19	24.4 ± 0.20	0.0180	24.4 ± 0.20	24.4 ± 0.20	0.00
INR	1.51 ± 0.67	1.27 ± 0.31	0.478	1.4 ± 0.57	1.3 ± 0.32	0.216
Platelet count (k/µL)	108.3 ± 76.2	159.8 ± 108.0	0.551	144.2 ± 92.5	151.0 ± 97.0	0.0718
aPTT (s)	37.68 ± 13.6	34.3 ± 10.1	0.282	34.8 ± 12.0	34.4 ± 10.2	0.0359
Albumin (g/dL)	2.8 ± 0.70	2.9 ± 0.68	0.118	2.9 ± 0.70	2.9 ± 0.67	0.00
Tbili (mg/dL)	5.88 ± 8.57	3.68 ± 6.49	0.288	4.0 ± 7.1	3.8 ± 6.6	0.0292
SCr (mg/dL)	1.65 ± 1.41	1.59 ± 1.50	0.0414	1.5 ± 1.3	1.6 ± 1.5	0.0713
Hemoglobin (g/dL)	10.0 ± 2.3	10.7 ± 2.1	0.269	10.4 ± 2.3	10.7 ± 2.1	0.136
Liver disease etiology			0.0964			0.0416
Alcoholic	745 (34.4)	296 (31.2)	0.0964	278 (30.8)	286 (31.7)	0.0416
NASH	75 (3.5)	25 (2.6)		27 (3.0)	22 (2.4)
Other¹	1239 (57.2)	585 (61.7)		563 (62.3)	557 (61.7)
Acute hepatitis	107 (4.9)	42 (4.4)		35 (3.9)	38 (4.2)
MELD score	21.1 ± 10.3	17.2 ± 8.3	0.422	17.0 ± 9.1	17.4 ± 8.3	0.0459
MELD category			0.431			0.210
>40	102 (4.7)	8 (0.8)	0.431	20 (2.2)	8 (0.89)	0.210
30-39	364 (16.8)	74 (7.8)		71 (7.9)	74 (8.2)
20-29	637 (29.4)	238 (25.1)		205 (22.7)	233 (25.8)
10-19	692 (31.9)	402 (42.4)		338 (37.4)	386 (42.7)
< 10	371 (17.1)	226 (23.8)		269 (29.8)	202 (22.4)

Data presented as n (%) or mean ± SD.

¹Other liver disease includes primary sclerosing cholangitis, biliary cirrhosis, cirrhosis due to alpha-1 antitrypsin deficiency, and any other liver disease not included above. RRT: Renal replacement therapy; CKD: Chronic kidney disease; MVP: Mechanical venous thromboembolism prophylaxis; BMI: Body mass index; INR: International normalized ratio; aPTT: Activated partial thromboplastin time; Tbili: Total bilirubin; SCr: Serum creatinine; NASH: Non-alcoholic steatohepatitis; MELD: Model for end-stage liver disease; ASD: Absolute standardized difference.

Citation: Yerke J, Bauer SR, Bass S, Torbic H, Militello M, Roach E, Hanouneh I, Welch S. Effectiveness of venous thromboembolism prophylaxis in patients with liver disease. World J Hepatol 2019; 11(4): 379-390
URL: https://www.wjgnet.com/1948-5182/full/v11/i4/379.htm
DOI: https://dx.doi.org/10.4254/wjh.v11.i4.379