Increasing rates of venous thromboembolism among hospitalised patients with inflammatory bowel disease: a nationwide analysis

Abstract

Summary Background Venous thromboembolism (VTE) is a significant cause of morbidity and mortality among patients with inflammatory bowel disease (IBD). However, data on national trends remain limited. Aims To assess national trends in VTE‐associated hospitalisations among patients with IBD as well as risk factors for, and mortality associated with, these events Methods Using the U.S. Nationwide Inpatient Sample from 2000–2018, temporal trends in VTE were assessed using the National Cancer Institute's Joinpoint Regression Program with estimates presented as the average annual percent change (AAPC) with 95% confidence intervals (CIs). Results Between 2000 and 2018, there were 4,859,728 hospitalisations among patients with IBD, with 128,236 (2.6%) having a VTE, and 6352 associated deaths. The rate of VTE among hospitalised patients with IBD increased from 192 to 295 cases per 10,000 hospitalisations (AAPC 2.4%, 95%CI 1.4%, 3.4%, p < 0.001), and remained significant when stratified by ulcerative colitis (UC) and Crohn's disease as well as by deep vein thrombosis and pulmonary embolism. On multivariable analysis, increasing age, male sex, UC (aOR: 1.30, 95%CI 1.26, 1.33), identifying as non‐Hispanic Black, and chronic corticosteroid use (aOR: 1.22, 95%CI 1.16, 1.29) were associated with an increased risk of a VTE‐associated hospitalisation. Conclusion Rates of VTE‐associated hospitalisations are increasing among patients with IBD. Continued efforts need to be placed on education and risk reduction.

The Journey Through the Pathogenesis and Treatment of Venous Thromboembolism in Inflammatory Bowel Diseases: A Narrative Review

“…72 73 Systemic corticosteroids were associated with significantly higher rate of VTE complications in IBD patients compared with IBD patient without steroid medication (OR: 1.22; 95% CI: 1.16–1.29). 8 Corticosteroids can induce hypercoagulability, by increasing plasma fibrinogen level and decreasing tPA activity and prostacyclin synthesis. 74 Furthermore, the use of corticosteroids before hospitalization is an independent risk for VTE.…”

“…The incidence of VTE increases with age, and it is associated with active disease (defined as corticosteroid use) and hospitalization. 2 Although most studies found no significant sex-related differences in VTE incidence, it was recently reported that male sex may be associated with an increased risk of VTE-related hospitalization [6][7][8] ; the extent of the disease may also correlate with a higher VTE risk. 9 A retrospective study found pancolonic involvement in 76% of patients with UC and VTE, whereas colonic involvement, complicated disease (i.e., fistulas, stenosis, abscesses), and recent surgery were reported as risk factors for CD.…”

Letter: fighting the battle but losing the war—inflammatory bowel disease and venous thromboembolism

“…We read with special interest the recently published work by Faye et al 1 regarding the time trends of venous thromboembolism (VTE) events in patients hospitalised for any cause with a diagnosis of inflammatory bowel disease (IBD). Their analysis, utilising the U.S. Nationwide Inpatient Sample (NIS) from 2000 to 2018, observed that 4,859,728 hospitalizations of patients with IBD included 128,236 (2.6%) having a VTE event, with 6352 associated deaths.…”

Letter: fighting the battle but losing the war—inflammatory bowel disease and venous thromboembolism. Authors' reply

“…The authors' declarations of personal and financial interests are unchanged from those in the original article. 3…”