Table of Contents
Thrombosis
Volume 2013 (2013), Article ID 807526, 7 pages
http://dx.doi.org/10.1155/2013/807526
Research Article

Venous Thromboembolism in Critically Ill Cirrhotic Patients: Practices of Prophylaxis and Incidence

1Intensive Care Department, King Abdulaziz Medical City, Mail Code 1425, P.O. Box 22490, Riyadh 11426, Saudi Arabia
2College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh 11426, Saudi Arabia
3Epidemiology and Biostatistics, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, P.O. Box 22490, Riyadh 11426, Saudi Arabia
4Department of Internal Medicine, American University of Beirut Medical Center, P.O. Box 11-0236, Beirut 1107 2020, Lebanon

Received 12 June 2013; Revised 3 September 2013; Accepted 21 October 2013

Academic Editor: Edith Nutescu

Copyright © 2013 Hasan M. Al-Dorzi et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objectives. We compared venous thromboembolism (VTE) prophylaxis practices and incidence in critically ill cirrhotic versus noncirrhotic patients and evaluated cirrhosis as a VTE risk factor. Methods. A cohort of 798 critically ill patients followed for the development of clinically detected VTE were categorized according to the diagnosis of cirrhosis. VTE prophylaxis practices and incidence were compared. Results. Seventy-five (9.4%) patients had cirrhosis with significantly higher INR (2.2 ± 0.9 versus 1.3 ± 0.6, ), lower platelet counts (115,000 ± 90,000 versus 258,000 ± 155,000/μL, ), and higher creatinine compared to noncirrhotic patients. Among cirrhotics, 31 patients received only mechanical prophylaxis, 24 received pharmacologic prophylaxis, and 20 did not have any prophylaxis. Cirrhotic patients were less likely to receive pharmacologic prophylaxis (odds ratio, 0.08; 95% confidence interval (CI), 0.04–0.14). VTE occurred in only two (2.7%) cirrhotic patients compared to 7.6% in noncirrhotic patients ( ). The incidence rate was 2.2 events per 1000 patient-ICU days for cirrhotic patients and 3.6 events per 1000 patient-ICU days for noncirrhotics (incidence rate ratio, 0.61; 95% CI, 0.15–2.52). On multivariate Cox regression analysis, cirrhosis was not associated with VTE risk (hazard ratio, 0.40; 95% CI, 0.10–1.67). Conclusions. In critically ill cirrhotic patients, VTE incidence did not statistically differ from that in noncirrhotic patients.