How do you decide whether to use pharmacologic VTE prophylaxis in hospitalized patients with decompensated cirrhosis?

For all patients, I begin by using a standard risk prediction tool to determine if the patient is appropriate for pharmacologic VTE prophylaxis. At our institution, the Padua risk prediction tool is embedded in our electronic health record/admission set. Clinical guidelines- including those from the AGA and the International Society of Thrombosis and Hemostasis (ISTH)- favor pharmacologic prophylaxis for patients with cirrhosis who otherwise meet criteria for prophylaxis, although many patients ...

Standard anticoagulation prophylaxis is recommended for venous thromboembolism (VTE) prophylaxis in hospitalized patients with cirrhosis who otherwise meet standard criteria for VTE prophylaxis, according to the American Gastroenterological Association (AGA). The AGA makes a conditional recommendation for this approach, based on very low certainty evidence.

Contraindications to pharmacologic prophylaxis would be active or recent bleeding (from EVs, portal gastropathy, ulcer, etc.) or severe thro...

Use VTE prophylaxis unless contraindicated. INR is not reliable because of unknown protein C, protein S, and antithrombin activity. PLT >50k is safe to start DVT prophylaxis. Cases with PLT 20k-50k without active bleeding might need to be individualized.

The coagulability in a cirrhotic patient is very hard to tell. Elevated INR is not a useful tool to determine the coagulation status. Decompensated cirrhosis is best described as simultaneously bleeding-prone and thrombosis-prone. It's challengi...