Thromboprophylaxis for Venous Thromboembolism Prevention in Hospitalized Patients with Cirrhosis

Publication Date: July 24, 2022
Last Updated: October 24, 2022

Recommendations

We suggest inclusion of portal vein thrombosis as a distinct clinically important endpoint for future studies.
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We recommend against the use of thrombocytopenia and/or prolongation of prothrombin time/international normalized ratio as absolute contraindications to anticoagulant thromboprophylaxis.
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We suggest anticoagulant thromboprophylaxis in line with local protocols and suggest low molecular weight heparin (LMWH) or fondaparinux over unfractionated heparin (UFH). In renal impairment, we suggest LMWH over UFH. For critically ill patients, we suggest case-by-case consideration of thromboprophylaxis.
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We recommend research to refine VTE risk stratification, and to establish the optimal dosing and duration of thromboprophylaxis.
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Recommendation Grading

Overview

Title

Thromboprophylaxis for Venous Thromboembolism Prevention in Hospitalized Patients with Cirrhosis

Authoring Organization

International Society on Thrombosis and Haemostasis

Publication Month/Year

July 24, 2022

Last Updated Month/Year

April 1, 2024

Supplemental Implementation Tools

Document Type

Consensus

Country of Publication

US

Document Objectives

Hospital-associated venous thromboembolism (HA-VTE) is a major cause of morbidity and mortality and is internationally recognized as a significant patient safety issue. While cirrhosis was traditionally considered to predispose to bleeding, these patients are also at an increased risk of VTE, with an associated increase in mortality. Hospitalization rates of patients with cirrhosis are increasing, and decisions regarding thromboprophylaxis are complex due to the uncertain balance between thrombosis and bleeding risk. This is further accentuated by derangements of hemostasis in patients with cirrhosis that are often considered contraindications to pharmacological thromboprophylaxis. Due to the strict inclusion and exclusion criteria of seminal studies of VTE risk assessment and thromboprophylaxis, there is limited data to guide decision making in this patient group. This guidance document reviews the incidence and risk factors for HA-VTE in patients with cirrhosis, outlines evidence to inform the use of thromboprophylaxis, and provides pragmatic recommendations on VTE prevention for hospitalized patients with cirrhosis.

Inclusion Criteria

Male, Female, Adult, Older adult

Health Care Settings

Hospital, Outpatient

Intended Users

Nurse, nurse practitioner, physician, physician assistant

Scope

Management, Prevention

Diseases/Conditions (MeSH)

D054556 - Venous Thromboembolism, D008103 - Liver Cirrhosis

Keywords

cirrhosis, Venous Thromboembolism, Thrombosis in cirrhosis

Source Citation

Roberts LN, Hernandez-Gea V, Magnusson M, Stanworth S, Thachil J, Tripodi A, Lisman T. Thromboprophylaxis for venous thromboembolism prevention in hospitalized patients with cirrhosis: Guidance from the SSC of the ISTH. J Thromb Haemost. 2022 Oct;20(10):2237-2245. doi: 10.1111/jth.15829. Epub 2022 Aug 10. PMID: 35948998.