The incidence of venous thromboembolism and practice of deep venous thrombosis prophylaxis in hospitalized cirrhotic patients

A retrospective cohort study was performed in a tertiary teaching hospital. We included all adult patients admitted to the hospital with a diagnosis of liver cirrhosis from January 1, 2009 to December 31, 2009. We grouped our cohort patients in two groups, cirrhotic patients without VTE and cirrhotic with VTE.Over one year, we included 226 cirrhotic patients, and the characteristics of both groups were similar regarding their clinical and laboratory parameters and their outcomes. Six patients (2.7%) developed VTE, and all of the VTEs were DVT. Hepatitis C was the most common (51%) underlying cause of liver cirrhosis, followed by hepatitis B (22%); 76% of the cirrhotic patients received neither pharmacological nor mechanical DVT prophylaxis.Cirrhotic patients are at risk for developing VTE. The utilization of DVT prophylaxis was suboptimal.Liver cirrhosis is a major health problem worldwide, especially in Saudi Arabia[1] where the prevalence of liver cirrhosis is not precisely known but is expected to be high due to the relatively high prevalence of viral hepatitis[2-4]. Liver cirrhosis is accompanied by multiple changes in the hemostatic system due to the reduced levels of natural inhibitors of coagulation and coagulation factors because of the impaired hepatic synthetic activity [5]. Thus, the global effect of liver disease on hemostasis is complex, and therefore, patients with liver cirrhosis can experience bleeding or thrombotic complications [6]. The pathogenesis of venous thromboembolism (VTE) in cirrhosis is complex and involves several factors, both endogenous changes associated with cirrhosis with increased levels of factors VII and also protein C activity is limited in the absence of the endothelial receptor thrombomodulin and therefore it cannot exert its full anti-coagulant activity as well as external factors, one of which is limited physical activity due to the disease itself [7-10]. The incidence of VTE among high-risk hospitalized patients has been re