P1770 - Efficacy and Utilization of Deep Venous Thrombosis Prophylaxis in Hospitalized Cirrhotic Patients: Are We Doing Enough?

Amit R. Hudgi, MBBS¹, Mohammad U. Azam, MD¹, Liana Mosley, MD¹, Haoran Peng, MD, PhD¹, Michael Coles, MD¹, Pearl Uy, MD¹, John Erikson Yap, MD², Subbaramia Sridhar, MBBS, MPH, FRCP, FRCPC, FACG^3
1Medical College of Georgia, Augusta, GA; ²Medical College of Georgia at Augusta University, Augusta, GA; ³AUMC, Augusta, GA

Introduction: Deep venous thrombosis (DVT) is one of the known causes of increased morbidity & mortality in hospitalized patients. These can be prevented with pharmacologic prophylaxis using heparin or enoxaparin. Hepatic cirrhosis leads to impaired hemostasis leading to both increased risk of bleeding & thrombosis. DVT prophylaxis is largely underused in this set of population. We aim to identify the utilization & efficacy of pharmacologic DVT prophylaxis in preventing DVT among cirrhotic patients hospitalized for more than 48 hours.

Methods: In our single-center study from 2017 to 2020 of cirrhotic patients ( >18 years) admitted to the hospital for more than 48 hours were included after the IRB approval. The DVT prophylaxis given to patients were obtained through the billing codes & manual verification. Hospital records were reviewed for the occurrence of DVT after 48 hours of admission to the hospital confirmed with a radiologic test. Other co-morbidities including heart & kidney disease, neoplasm of the liver, ICU admission & in-hospital mortality were tabulated (table-1).

Results: A total of 1399 patients were included in the analysis (M=880, F=543, mean age 56.91 yr). While 618 subjects did not receive any DVT prophylaxis, 614 received subcutaneous heparin & 166 enoxaparin. There were a total of 38 thrombotic events; 7 in the enoxaparin group, 14 in the subcutaneous heparin group & 16 in those who did not receive any therapy. Relative risk for developing a thrombotic event for enoxaparin group & subcutaneous heparin group were 1.57 (p=0.31) & 0.87 (p=0.69) when compared to the non-prophylaxis group. Sub-group analysis showed that patients admitted to ICU had Odds of 8.89 (95% CI, 1.58, 49.83) times of developing a thrombotic event when compared to patients admitted to medical-surgical wards.

Discussion: DVT prophylaxis was largely underutilized with 44.25 % of patients not receiving any form of pharmacologic prophylaxis. Patients admitted to the ICU are at higher risk of DVT & therefore benefit from DVT prophylaxis. The limitations of our study were the retrospective nature & small population size. Physicians treating cirrhotic patients should be aware of the thrombotic risk and DVT prophylaxis cautiously administered. We are currently conducting a larger population study with stratification based on the bleeding risk during admission.

Non-prophylaxis group Heparin group Enoxaparin group Total (n)	619 614 166 1399
Male Female	866 533
White Black Asian Others Declined	882 460 17 32 8
Non-Hispanic Hispanic	1373 26
Neoplasm of liver Kidney disease Heart disease Lung disease Diabetes mellites	120 161 434 251 547
ICU stay (average) In-hospital mortality	499 (1.65) 121

Table: Table-1 Baseline characteristics


Disclosures:
Amit Hudgi indicated no relevant financial relationships.
Mohammad Azam indicated no relevant financial relationships.
Liana Mosley indicated no relevant financial relationships.
Haoran Peng indicated no relevant financial relationships.
Michael Coles indicated no relevant financial relationships.
Pearl Uy indicated no relevant financial relationships.
John Erikson Yap indicated no relevant financial relationships.
Subbaramia Sridhar indicated no relevant financial relationships.


Amit R. Hudgi, MBBS¹, Mohammad U. Azam, MD¹, Liana Mosley, MD¹, Haoran Peng, MD, PhD¹, Michael Coles, MD¹, Pearl Uy, MD¹, John Erikson Yap, MD², Subbaramia Sridhar, MBBS, MPH, FRCP, FRCPC, FACG³. P1770 - Efficacy and Utilization of Deep Venous Thrombosis Prophylaxis in Hospitalized Cirrhotic Patients: Are We Doing Enough?, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.