PMID- 35948998
OWN - NLM
STAT- MEDLINE
DCOM- 20220922
LR  - 20230829
IS  - 1538-7836 (Electronic)
IS  - 1538-7836 (Linking)
VI  - 20
IP  - 10
DP  - 2022 Oct
TI  - Thromboprophylaxis for venous thromboembolism prevention in hospitalized patients 
      with cirrhosis: Guidance from the SSC of the ISTH.
PG  - 2237-2245
LID - 10.1111/jth.15829 [doi]
AB  - 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. In brief, in hospitalized patients with 
      cirrhosis: We suggest inclusion of portal vein thrombosis as a distinct 
      clinically important endpoint for future studies. We recommend against the use of 
      thrombocytopenia and/or prolongation of prothrombin time/international normalized 
      ratio as absolute contraindications to anticoagulant thromboprophylaxis. We 
      suggest anticoagulant thromboprophylaxis in line with local protocols and suggest 
      low molecular weight heparin (LMWH) or fondaparinux over unfractionated heparin 
      (UFH). In renal impairment, we suggest LMWH over UFH. For critically ill 
      patients, we suggest case-by-case consideration of thromboprophylaxis. We 
      recommend research to refine VTE risk stratification, and to establish the 
      optimal dosing and duration of thromboprophylaxis.
CI  - (c) 2022 International Society on Thrombosis and Haemostasis.
FAU - Roberts, Lara N
AU  - Roberts LN
AUID- ORCID: 0000-0003-3871-8491
AD  - King's Thrombosis Centre, Department of Haematological Medicine, King's College 
      Hospital, London, UK.
FAU - Hernandez-Gea, Virginia
AU  - Hernandez-Gea V
AUID- ORCID: 0000-0001-7937-984X
AD  - Barcelona Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clinic, IDIBAPS, 
      University of Barcelona, Red de Enfermedades Hepaticas y Digestivas (CIBEREHD), 
      Health Care Provider of the European Reference Network on Rare Liver Disorders 
      (ERN-Liver), Barcelona, Spain.
FAU - Magnusson, Maria
AU  - Magnusson M
AUID- ORCID: 0000-0001-5388-6608
AD  - Clinical Chemistry and Blood Coagulation Research, MMK, Department of Pediatrics, 
      CLINTEC, Karolinska Institutet, Department of Hematology, Karolinska University 
      Hospital, Stockholm, Sweden.
FAU - Stanworth, Simon
AU  - Stanworth S
AUID- ORCID: 0000-0002-7414-4950
AD  - Transfusion Medicine, NHS Blood and Transplant, Oxford, UK.
AD  - Department of Haematology, Oxford University Hospitals, NHS Foundation Trust, 
      Oxford, UK.
AD  - Radcliffe Department of Medicine, University of Oxford and NIHR Oxford Biomedical 
      Research Centre (Haematology), Oxford, UK.
FAU - Thachil, Jecko
AU  - Thachil J
AUID- ORCID: 0000-0001-7218-0993
AD  - Department of Haematology, Manchester Royal Infirmary, Manchester, UK.
FAU - Tripodi, Armando
AU  - Tripodi A
AUID- ORCID: 0000-0003-1602-2776
AD  - IRCCS Ca' Granda Maggiore Hospital Foundation, Angelo Bianchi Bonomi Hemophilia 
      and Thrombosis Center and Fondazione Luigi Villa, Milan, Italy.
FAU - Lisman, Ton
AU  - Lisman T
AUID- ORCID: 0000-0002-3503-7140
AD  - Surgical Research Laboratory and Section of Hepatobiliary Surgery and Liver 
      Transplantation, Department of Surgery, University of Groningen, University 
      Medical Center Groningen, Groningen, the Netherlands.
LA  - eng
PT  - Journal Article
DEP - 20220810
PL  - England
TA  - J Thromb Haemost
JT  - Journal of thrombosis and haemostasis : JTH
JID - 101170508
RN  - 0 (Anticoagulants)
RN  - 0 (Heparin, Low-Molecular-Weight)
RN  - 9005-49-6 (Heparin)
RN  - J177FOW5JL (Fondaparinux)
SB  - IM
MH  - Anticoagulants/adverse effects
MH  - Fondaparinux/therapeutic use
MH  - Heparin/adverse effects
MH  - Heparin, Low-Molecular-Weight/adverse effects
MH  - Humans
MH  - Liver Cirrhosis/complications/diagnosis
MH  - *Thrombosis/drug therapy
MH  - *Venous Thromboembolism/diagnosis/etiology/prevention & control
OTO - NOTNLM
OT  - liver cirrhosis
OT  - liver diseases
OT  - prevention
OT  - thromboprophylaxis
OT  - venous thrombosis
EDAT- 2022/08/11 06:00
MHDA- 2022/09/23 06:00
CRDT- 2022/08/10 23:41
PHST- 2022/07/08 00:00 [revised]
PHST- 2022/06/12 00:00 [received]
PHST- 2022/07/18 00:00 [accepted]
PHST- 2022/08/11 06:00 [pubmed]
PHST- 2022/09/23 06:00 [medline]
PHST- 2022/08/10 23:41 [entrez]
AID - S1538-7836(22)19057-4 [pii]
AID - 10.1111/jth.15829 [doi]
PST - ppublish
SO  - J Thromb Haemost. 2022 Oct;20(10):2237-2245. doi: 10.1111/jth.15829. Epub 2022 
      Aug 10.