Prophylactic Anticoagulation in Cirrhotic Patients Admitted to the Hospital | Patient Case Quiz

A 61-year-old obese female with a history of cirrhosis due to non-alcoholic fatty liver disease presents to the hospital after a syncopal event at home. Echocardiography has revealed severe aortic stenosis, and she is being admitted to the cardiology service for further evaluation and consideration for aortic valve replacement. She denies any prodromal symptoms before this event, but does describe episodes of chest heaviness and exertional shortness of breath that have been taking place with increasing frequency over the past year. She does not have a history of coronary artery disease, and has never been evaluated by a cardiologist. On review of systems, she denies chest pain, palpitations or dyspnea. She has not had any recent illnesses, fevers, or chills, and she reports no past or current episodes of bright red blood per rectum, melena, or hemoptysis. The remainder of her review of systems is negative.

Recently, she underwent outpatient esophagogastroduodenoscopy (EGD), which revealed grade II esophageal varices, for which she now takes the non-selective beta-blocker, nadolol. She has never had ascites or hepatic encephalopathy.

The initial laboratory studies reveal a normal basic metabolic panel with creatinine 0.8 mg/dL. Her white blood cell count is 7 x 109/L, hemoglobin is 12 g/dL, and platelets are 95 x 109/L. Her aspartate aminotransferase (AST) is 45 IU/L, and alanine aminotransferase (ALT) is 57 IU/L. The remainder of the liver function testing is normal. Her international normalized ratio (INR) is 2.1.

Should this patient receive prophylactic anticoagulation at the time of hospital admission for the prevention of venous thromboembolism (VTE) while undergoing a cardiovascular evaluation for syncope?

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