Journal Club: enoxaparin use in cirrhosis

This journal club dealt with enoxaparin for cirrhotic patients.  Anticoagulation for cirrhotic patients? Yes. The concept behind this trial was that there are microthromboses at the level of bowel wall perfusion that lead to subtle ischemic damage and subsequent increased permeability.  Bacteria and bacterial products can then enter the circulation and worsen portal hypertension etc. 

The aim of this study was to determine whether prophylactic enoxaparin can decrease the rate of de novo portal vein thrombosis at 48 weeks.  Secondary endpoints included the rate of decompensation and mortality.  Although over 300 patients were screened, only 60 enrolled in this placebo controlled study. 

There were significantly more portal vein thromboses in the placebo arm compared to the enoxaparin arm; in fact, non of the enoxaparin patients developed PVT.  Fortunately, bleeding side effects were not significantly increased in the study arm.  Rates of decompensation were also lower (12 vs 60%), which was significant.  Mortality did not change.

For more details about this recent Gastroenterology article, please click on the link below:

https://www.dropbox.com/s/oludld4dbgks8vy/Enoxaparin%20for%20cirrhosis%20GASTRO%202012.pdf

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