992 Venous Thromboembolism Prophylaxis in Hospitalized Patients With Chronic Liver Disease and the Bleeding and Thrombosis Risk: A Systematic Review and Meta-Analysis
Bibliographic record
Abstract
INTRODUCTION: Patients with chronic liver disease, especially cirrhosis have an increased risk in both venous thromboembolism (VTE) and bleeding. Most of hospitalized chronic liver disease patients, however, were not given the VTE prophylaxis during admission. METHODS: A systematic search was conducted for studies published up to May 2019 using MEDLINE, EMBASE, and Cochrane Library. We included cohort studies of patients with chronic liver disease who were hospitalized for ≥48 hours which compared patients with and without VTE prophylaxis. Study quality was assessed using Newcastle-Ottawa scale (NOS). A random-effects model was used to determine relative risk (RR) with 95% confidence interval (CI) for bleeding and thrombotic events. RESULTS: After screening 2462 abstracts, 188 potentially studies were assessed. Seven retrospective cohorts met the criteria and were included in this meta-analysis. Only one study matched intervention group and controls and was done with propensity score. In total, there were 1,855 patients who received VTE prophylaxis and 2,915 patients who did not receive VTE prophylaxis. Regarding bleeding events, there were 76 patients (4.0%) and 231 patients (7.9%) in prophylaxis and no prophylaxis group, respectively. There was no increase of bleeding event in the VTE prophylaxis compared to the no-VTE prophylaxis group with pulled RR of 0.70 (0.30–1.64, I2 = 87%). Regarding thrombosis risk, there were 34 patients (1.8%) and 68 patients (2.3%) in prophylaxis and no prophylaxis group, respectively. There was no increase of thrombosis event in the VTE prophylaxis compared to the no-VTE prophylaxis group with pulled RR of 0.76 (0.44-1.31, I2 = 17%). When included only patients with INR ≥ 1.4 or with cirrhosis, the RR of patients with VTE prophylaxis for bleeding was 0.73 (0.31–1.69, I2 = 74%) and thrombosis was 1.13 (0.67–1.92, I2 = 0%). CONCLUSION: This meta-analysis found no difference of bleeding and thrombosis events between chronic liver disease patients with and without VTE prophylaxis. The similar results were seen with subgroup analysis of patients with elevated INR or cirrhosis. However, with limitation of retrospective study, the patients who received prophylaxis tended to have less advanced liver disease, which potentially had less risk of bleeding and risk of thrombosis. Further study with liver disease staging and coagulopathy risk matched for intervention and control groups is warranted.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.010 | 0.022 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.018 | 0.029 |
| Bibliometrics | 0.008 | 0.010 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.001 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".