Thromboprophylaxis for Venous Thromboembolism Prevention in Hospitalized Patients with Cirrhosis
Recommendations
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 25, 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.