Factors Affecting Physician Decision to Utilize Prophylactic Anticoagulation in Hospitalized Cirrhotic Patients

Abstract

Purpose: To investigate which factors are most likely to influence a physician's decision on whether or not to prophylactically anticoagulate a hospitalized cirrhotic patient to protect against venous thromboembolism (VTE), with a secondary aim to determine associated adverse outcomes, including VTE and bleeding events. Methods: This study is a retrospective cohort study of hospitalized cirrhotic patients at one Veterans Affairs Medical Center between 01/01/2005 and 12/31/2011. Data were collected from electronic medical records, and the primary outcome was whether or not anticoagulation was used. Additional data gathered include: etiology of cirrhosis, age, sex, prothrombin time (PT), platelet count, creatinine, bilirubin, albumin, history of esophageal varices, history of previous gastrointestinal bleeding, previous VTE, and active malignancy. Chi-squared testing and logistical regression was used in the analysis, and a p-value <0.05 was considered significant. VTE outcomes with and without anticoagulation and bleeding complications when given anticoagulation were also collected as part of a secondary aim of the study. Results: One hundred twenty-five patient charts were reviewed. 97.6% of patients were men, and the average age was 60. Overall, 53% of the cirrhotic patients received anticoagulation. In univariate analysis, PT, platelet count, albumin, creatinine, and bilirubin all were significantly related to use of anticoagulation. In multivariate analysis, only PT, platelet count, and albumin were independently significantly related to the use of anticoagulation. Anticoagulation use was more likely the higher the platelet count, and the albumin, and the lower the PT. There were no adverse bleeding complications in any patients. There was one incident of deep vein thrombus in a patient receiving anticoagulation. Conclusion: This study demonstrates that the factors most likely to influence a physician to anticoagulate a cirrhotic patient in the hospital are: PT, platelets, and albumin. This finding may aid in better understanding how to utilize low-dose anticoagulation in hospitalized cirrhotic patients, with the goal to minimize VTE outcomes while concurrently minimizing bleeding complications. Currently, there are no guidelines that help to direct use of prophylactic anticoagulation in cirrhotic patients, despite this being a common management dilemma.