Bleeding Risk of Therapeutic Unfractionated Heparin and Low Molecular Weight Heparin in Patients with Cirrhosis

  • Katherine L. Summers
  • Kyle A. Davis
  • Sarah A. NislyEmail author
Short Communication


Background and Objective

Patients with cirrhosis are simultaneously at an increased risk of bleeding and thrombosis. Studies comparing the safety of parenteral anticoagulants in this population are lacking. This study evaluated the safety of therapeutic unfractionated heparin versus low molecular weight heparin in patients with cirrhosis.


This system-wide, retrospective cohort study included adults with cirrhosis receiving unfractionated heparin or low molecular weight heparin for the treatment of acute venous thromboembolism. The primary endpoint was the incidence of major bleeding.


Eighty-two patients were included in this study, with 52 receiving unfractionated heparin and 30 receiving low molecular weight heparin. More major bleeding occurred in the unfractionated heparin arm compared to the low molecular weight heparin arm (19.2% vs 0%, p = 0.010).


Low molecular weight heparin may be a safer option in patients with cirrhosis treated for acute venous thromboembolism, but future studies should confirm these findings.


Compliance with Ethical Standards


No source of funding.

Conflict of Interest

All authors have no conflict of interest to declare.

Ethical Approval

This study was approved by the Wake Forest University Health Sciences Institutional Review Board (IRB 00053577).

Informed Consent

Written informed consent was not required as this was a retrospective chart review.


  1. 1.
    Tripodi A, Mannucci PM. The coagulopathy of chronic liver disease. N Engl J Med. 2011;365(2):147–56.CrossRefGoogle Scholar
  2. 2.
    Dhar A, Mullish BH, Thursz MR. Anticoagulation in chronic liver disease. J Hepatol. 2017;66(6):1313–26.CrossRefGoogle Scholar
  3. 3.
    Intagliata NM, Northup PG. Anticoagulant therapy in patients with cirrhosis. Semin Thromb Hemost. 2015;41(5):514–9.CrossRefGoogle Scholar
  4. 4.
    Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inf. 2009;42(2):377–81.CrossRefGoogle Scholar
  5. 5.
    Schulman S, Kearon C. Definition of major bleeding in clinical investigations of antihemostatic medicinal products in non-surgical patients. J Thromb Haemost. 2005;3(4):692–4.CrossRefGoogle Scholar
  6. 6.
    Kwon J, Koh Y, Yu SJ, Yoon JH. Low-molecular-weight heparin treatment for portal vein thrombosis in liver cirrhosis: efficacy and the risk of hemorrhagic complications. Thromb Res. 2018;163:71–6.CrossRefGoogle Scholar
  7. 7.
    Drolz A, Horvatits T, Roedl K, et al. Coagulation parameters and major bleeding in critically ill patients with cirrhosis. Hepatology. 2016;64(2):556–68.CrossRefGoogle Scholar
  8. 8.
    Sogaard KK, Horvath Puho E, Gronbaek H, Jepsen P, Vilstrup H, Sorensen HT. Risk of venous thromboembolism in patients with liver disease: a nationwide population-based case-control study. Am J Gastroenterol. 2009;104:96–101.CrossRefGoogle Scholar
  9. 9.
    Gulley D, Teal E, Suvannasankha A, Chalasani N, Liangpunsakul S. Deep vein thrombosis and pulmonary embolism in cirrhosis patients. Dig Dis Sci. 2008;53:3012–7.CrossRefGoogle Scholar
  10. 10.
    Wu H, Nguyen GC. Liver cirrhosis is associated with venous thromboembolism among hospitalized patients in a nationwide US study. Clin Gastroenterol Hepatol. 2010;8:800–5.CrossRefGoogle Scholar
  11. 11.
    Qi X, De Stefano V, Li H, Dai J, Guo X, Fan D. Anticoagulation for the treatment of portal vein thrombosis in liver cirrhosis: a systematic review and meta-analysis of observational studies. Eur J Intern Med. 2015;26(1):23–9.CrossRefGoogle Scholar
  12. 12.
    Loffredo L, Pastori D, Farcomeni A, Violi F. Effects of anticoagulants in patients with cirrhosis and portal vein thrombosis: a systematic review and meta-analysis. Gastroenterology. 2017;153(2):480–7.CrossRefGoogle Scholar
  13. 13.
    Shatzel J, Dulai PS, Harbin D, Cheung H, Reid TN, Kim J, James SL, Khine H, Batman S, Whyman J, Dickson RC, Ornstein DL. Safety and efficacy of pharmacological thromboprophylaxis for hospitalized patients with cirrhosis: a single-center retrospective cohort study. J Thromb Haemost. 2015;13(7):1245–53.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of PharmacyWake Forest Baptist HealthWinston-SalemUSA
  2. 2.School of PharmacyWingate UniversityWingateUSA

Personalised recommendations