Table 2.
Hemorrhagic complications associated with anticoagulation in cirrhosis
| Author | Study design / Duration |
Patients with Cirrhosis | Anticoagulation | Hemorrhagic Complications (number of patients) |
|---|---|---|---|---|
| Garcia-Fuster et. al6 |
Retrospective 1992 – 2007 | VTE, n= 17 | LMWH, n= 11 VKA with 1 week of LMWH bridging, n= 6 |
83 % (14/17) : Minor 35% (6/17) : Severe requiring transfusion |
| Francoz et. al 50 |
Retrospective 1996 – 2001 |
SVT, n= 29 with 19 receiving anticoagulation | VKA with ≥ 5 days of LMWH bridging, n= 19 *Band ligation prior to anticoagulation |
5% (1/19) : Post-ligation bleeding ulcer that occurred as a complication of prophylactic variceal banding |
| Senzolo et. al 49 |
Prospective Unpublished | PVT, n= 38 with 26 selected for anticoagulation on the basis of bleeding risks (Exclusion: cavernous transformation, suboptimal results from endoscopic variceal banding) |
LMWH, n= 26 *Band ligation prior to anticoagulation |
4% (1/26) |
| Amitrano et. al 48 |
Prospective 2005 – 2006 |
PVT, n= 39 with 28 selected for anticoagulation (Exclusion: cavernous transformation of portal vein, hepatocellar carcinoma, Child-Pugh C disease) |
LMWH, n= 28 *Band ligation prior to anticoagulation |
7% (2/28) : Hypertensive gastropathy |
| Bechmann et. al 44 |
Prospective Unpublished | Immobolization/Thrombophilia/Advanced age/Low protein C/S levels/Malignancy/Stroke/Shock/Previous VTE, n= 75 (Exclusion: Cr clearance < 30 ml/min, history of heparin-induced thrombocytopenia or recent major bleeding event) PVT/SVT/Veno-occlusive disease/Prosthetic aortic valve/Atrial fibrillation, n= 9 |
Prophylactic LMWH, n= 75 LMWH, n= 9 |
7% (5/75) : Variceal bleed, hypertensive gastropathy 22% (2/9) : Variceal bleed, hypertensive gastropathy |
| Delgado et. al 47 |
Prospective 2003 – 2010 | PVT, n= 55 (Exclusion: cavernous transformation) |
LMWH, n= 26 LMWH (median: 17 days, range: 3–179 days) with transitioning to VKA, n= 21 VKA, n= 8 |
18% (10/55) Of these, 9% (5/55) thought to be anticoagulation related :oral, vaginal, surgical wound, lower GI, obscure GI bleed 9% (5/55) thought to be cirrhosis related ? : Variceal bleed |
| Villa et. al 51 | Prospective RCT Unpublished | n= 70 with 34 randomized to treatment arm (Study examining anticoagulation use in the prevention of PVT) |
LMWH, n= 34 | No hemorrhagic complications Withdrawal of 1 patient due to thrombocytopenia |
VTE = Deep vein thrombosis/PE, PVT = Portal vein thrombosis, SVT = Splanchnic vein thrombosis, Cr = Creatinine, GI= Gastrointestinal, RCT= Randomized control trial