**2.7 DVT prophylaxis in liver disease**

Current guidelines from American College of Chest Physicians (ACCP) DVT prophylaxis do not specifically comment on the advanced liver disease patients' population (Senzolo et al., 2009). The lack of specific guidelines is because of the perceived risk of bleeding complications, sense of auto-anticoagulation, impaired laboratory tests, and most important lack of clinical trials to support the practice of routine use of DVT prophylaxis in liver disease/cirrhosis and its safety, particularly the risk of bleeding is unknown. Recently two studies (Senzolo et al., 2009, Bechman et al .,2010).) found that the prophylactic use of LMWH in patients with cirrhosis and who are at high risk of thrombosis, to be safe from the risk of bleeding. Actually Bechman et al .,2010 revealed for the first time, to our knowledge, there are apparent decreased efficacy of LMWH in cirrhotic patients, which may indeed argue for studying the appropriate dosing in cirrhotic patients (Bechman et al., 2010).

In a recent study, approximately 76% of the cirrhotic patients included in the cohort received neither pharmacological nor mechanical DVT prophylaxis. No significant differences in the incidence of VTE were observed between the group that received pharmacologic or mechanical prophylaxis and the group that did not receive prophylaxis (Abdulaziz et al., 2011). The utilization of DVT prophylaxis was suboptimal.

Until the risks and benefits of VTE prophylaxis are established in this particular population, the VTE prophylaxis cannot be withdrawn in the cirrhotic population at present time. (Senzolo et al., 2009).
