Bleeding risk of warfarin therapy among cirrhotic patients

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Watsaporn Nakornchai
Ponlapat Rojnuckarin


Background: Although cirrhosis is often associated with thrombocytopenia and coagulopathy, it provides no protection from thromboembolism. Some of these patients require anticoagulants that may cause more complications. A study in this particular group would provide helpful guidelines to make clinical decisions to prescribe appropriate medication.

Objective: To compare the bleeding side effects and thromboembolism during anticoagulant use in patients with liver cirrhosis and the control group.

Methods: This comprised a retrospective cohort study reviewing the medical records of warfarin use among patients with cirrhosis compared with age-matched patients without cirrhosis.

Results: The study enrolled 102 participants, 32 patients with cirrhosis and 70 controls. In the cirrhotic group, 78.1%, 18.8%, and 3.1% revealed Child Pugh scores A, B, and C, respectively. The high bleeding risk (HAS-BLED score ≥3) did not differ between 2 groups. In the cirrhotic group, the number of major bleeding, nonmajor bleeding, and thromboembolism cases totaled 34.4%, 31.3%, and 9.4% respectively, and those of the control group were 11.4%, 22.9%, and 10.0%, respectively. The odds ratios were 4.06 (95% Confidence interval [CI] 1.44-11.44, p = 0.008) for major bleeding, 1.53 (95%CI 0.60-3.90, p = 0.369) for non major bleeding and 0.93 (95%CI 0.22-3.86, p = 0.922) for thromboembolism. The significant predictors of major bleeding were liver cirrhosis and alcohol consumption. Multivariate analysis revealed cirrhosis was still associated with major bleeding with the odds ratio of 3.04 (95%CI 1.01-9.14, p = 0.047).

Summary This study found that warfarin use among patients with cirrhosis was associated with 3 times more major bleeding cases compared with the control.


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นิพนธ์ต้นฉบับ (Original article)


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