In this episode, I’ll discuss whether patients with liver disease and prolonged PT/INR levels still need VTE prophylaxis.
Patients with liver disease and prolonged PT/INR levels appear to be teetering between the risk of bleeding and the risk of clotting.
In a patient with cirrhosis, simply having a prolonged PT or INR does not necessarily mean the patient is “auto-anticoagulated.”
Hospitalized patients with liver disease are at risk of VTE, and risk-stratification tools like the Padua Predictor Score (PPS) can be used to determine high vs low risk of VTE.
A retrospective cohort study of 235 patients appears to show that the risk of bleeding is not significantly different in patients with liver disease who receive VTE prophylaxis compared to those who do not.
Another retrospective chart review study showed a higher risk of bleeding in patients with chronic liver disease, although it was predominantly minor bleeding.
While most hospitalized patients with liver disease will need VTE prophylaxis, the decision should be individualized based on the risk of VTE, platelet count, and degree of baseline coagulopathy.
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