Coagulopathy Does Not Protect Against Venous Thromboembolism in Hospitalized Patients with Chronic Liver Disease.
Chest. 2009 Dec 29;
Authors: Dabbagh O, Oza A, Prakash S, Sunna R, Saettele TM
BACKGROUND: 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 0.5-1.9% in CLD patients .We sought to evaluate VTE incidence among hospitalized CLD patients according to INR levels. METHODS: This is a retrospective cohort study performed at a tertiary university hospital. We included all adult patients admitted with a primary diagnosis of CLD over a seven 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. RESULTS: Over 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<0.001), 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=0.602).VTE prophylaxis was not utilized in 75% of patients. CONCLUSIONS: 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. Utilization of DVT prophylaxis was extremely low in this population.
PMID: 20040609 [PubMed - as supplied by publisher]