Frequency and risk factors of thromboembolic complications in patients with inflammatory bowel diseases

Abstract

Inflammatory bowel diseases (IBD) are characterised by chronic immune inflammation of the mucous membrane and/or the thickness of the intestinal wall, and are also accompanied by disorders of the blood clotting system and the development of a hypercoagulation state. The aim of this study was to identify the frequency of thromboembolic complications (TEC) in IBD patients and to determine the influence of acquired and inherited hypercoagulation factors that contribute to the development of TEC. The clinical status of 1238 IBD patients who were treated in 2019 was evaluated. Of these, 748 patients suffered from ulcerative colitis (UC) and 490 had Crohn's disease (CD). Among the UC patients, there were 369 men (49.3%) and 379 women (50.7%). In 10.2% of patients with UC, there were clinically significant TEC. There were 227 men (46.3%) and 263 women (53.7%) among patients with CD. 7.3% of patients with CD had clinically significant TEC. 112 (9.0 %) of 1238 IBD patients had clinically significant TEC. Among patients with UC (n = 748), 76 (10.2%) showed clinically significant TEC. Among patients with CD (n = 490), 36 (7.3%) had TEC. Of 112 IBD patients with clinically significant TEC, 45 (40.2%) had genetic polymorphisms that increased affinity for fibrinogen, increased platelet aggregation, and contributed to a decrease in the activity of folate cycle enzymes, including methylenetetrahydrofolate reductase, which may be manifested by a moderate increase in homocysteine levels. Of the 45 IBD patients with clinically significant TEC due to inherited factors, 30 (66.6%) patients had UC and 15 (33.7%) patients had CD (HR – 1.038, 95% CI 0.746–1.444; x2 – 0.049; p = 0.83921). 67 patients with IBD (59.8%) who had clinically significant TEC did not have genetic polymorphisms leading to hypercoagulation. Based on the analysis, we can conclude that risk factors for the development of TEC like the status of a smoker, long bed rest, taking hormonal contraceptives, varicose veins of the lower extremities, high activity of the disease, glucocorticosteroids therapy, the extent of intestinal damage in patients with IBD, and genetic factors, should be taken into account by gastroenterologists in the treatment of patients with UC and CD. The hereditary factor of hypercoagulation equally affects the development of TEC, both in patients with UC and CD.