COVID-19 and the Liver: A 2021 Update

Catherine W. Spearman; Alessio Aghemo; Luca Valenti; Mark W. Sonderup


Liver International. 2021;41(9):1988-1998. 

In This Article

Anticoagulation in the Setting of Chronic Liver Disease and COVID-19

Advanced liver disease is associated with both coagulopathy and an increased risk of venous thromboembolism. SARS-CoV-2 infection in cirrhotics potentially increases the cumulative risk of prothrombotic complications, and anticoagulation is recommended to prevent thromboembolic complications.[9,84] Low molecular weight heparin (LMWH) in cirrhotics has shown a survival benefit in decompensated cirrhotics presenting with portal vein thrombosis.[85] A systematic review indicated no excess of bleeding events including variceal bleeds in anticoagulated cirrhotic patients with a portal vein thrombosis.[86] In a recent multicentre Italian study, where 80% of cirrhotics with COVID-19 received LMWH thromboprophylaxis, no evidence of any major haemorrhagic complications was noted.[55] There is no contraindication to LMWH in hospitalized cirrhotics.