DVT prophylaxis in cirrhosis

Q: In patients with cirrhosis which of the following is preferred for Deep Venous Thrombosis (DVT) prophylaxis in ICU? (select one)

A) unfractionated heparin 
B) low molecular weight (LMW) heparin


Answer:  B 

 Unfractionated heparin requires antithrombin (AT) to inhibit thrombin and factor Xa. AT is synthesized in the liver. In patients with cirrhosis, their activity may be reduced. Low molecular weight (LMW) heparins are reliably effective for DVT prophylaxis in hospitalized patients. This also reinforce the fact that in patients with cirrhosis anti-factor Xa levels are not reliable to follow the anticoagulation activity.

#hepatology
#hematology


References:

1. Bechmann LP, Sichau M, Wichert M, et al. Low-molecular-weight heparin in patients with advanced cirrhosis. Liver Int 2011; 31:75. 

2. Fuentes A, Gordon-Burroughs S, Hall JB, et al. Comparison of anti-Xa and activated partial thromboplastin time monitoring for heparin dosing in patients with cirrhosis. Ther Drug Monit 2015; 37:40.