Predictors of venous thromboembolism in hospitalized patients with inflammatory bowel disease and colon cancer: A retrospective cohort study

Achebe, Ikechukwu; Mbachi, Chimezie; Palacios, Pedro; YuChen, Wang; Asotibe, Jennifer C; Ofori-Kuragu, Aaron; Gandhi, Seema

doi:10.1016/j.thromres.2020.12.017

Cited by 10 publications

(3 citation statements)

References 12 publications

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“…These associations are new and were not reported in earlier studies. The lower likelihood of these sub-group patients receiving pharmacological VTE prophylaxis, despite reports of higher VTE risk is worrying considering they are also at risk of disparities in their care [14][15][16][17][18][19][20][21]. Furthermore, given a significant part of our patient population, 30% were blacks and 25% were aged 65yrs and above, this likely contributed to the lower pharmacological VTE prophylaxis rate.…”

Section: Discussionmentioning

confidence: 89%

Venous Thromboembolism Prophylaxis in Inflammatory Bowel Disease: A Two-year Retrospective Study of Patients Presenting With Inflammatory Bowel Disease to a Community Hospital

Amakye¹,

Kesiena²,

Ademiluyi³

et al. 2022

Cureus

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We set out to determine the rate of pharmacological venous thromboembolism (VTE) prophylaxis among patients admitted with inflammatory bowel disease (IBD) and indirectly compare it to national trends. We also assessed the demographic and clinical correlates for non-prescription of pharmacologic VTE prophylaxis among IBD patients with and without a flare. MethodsWe extracted data from 123 patients admitted to our facility with IBD from September 2018 to August 2020 retrospectively. Out of this cohort, 26 patients were excluded and 96 were included in our analysis. Baseline characteristics were analyzed using descriptive statistics. Multiple logistic regression was used to evaluate the correlates of pharmacological VTE prophylaxis use in individuals with IBD and to analyze the predictors of VTE prophylaxis use in patients with IBD flares. ResultsOut of the 96 patients with IBD included in this study, 61 (63.5%) presented with an IBD flare, and among those with a flare, 26/61 (42.6%) received VTE prophylaxis. IBD patients aged ≥ 65 years and of Black race were less likely to be placed on pharmacological VTE prophylaxis (adjusted odds ratio (AOR) 0.20, 95% CI (0.06 -0.70), p-value 0.012) and (AOR 0.16, 95% CI (0.05 -0.50), p-value 0.002) respectively. Among those with a flare, the presence of bright red bleeding per rectum was associated with a low rate of pharmacologic VTE use (AOR 0.01, 95% CI (0.00 -1.78), p-value 0.001). Overall the rate of VTE prophylaxis use in the IBD patient cohort was 56.3% and this was irrespective of flare status. ConclusionOur study showed the low rate of pharmacologic VTE prophylaxis use in IBD patients at this center and this finding was in line with national trends. Interestingly age and the race of patients played a major role in the decision to provide pharmacological VTE prophylaxis but the reason for this finding was not explored by our study. A larger multi-center study is needed to further evaluate these relationships.

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Section: Discussionmentioning

confidence: 89%

Venous Thromboembolism Prophylaxis in Inflammatory Bowel Disease: A Two-year Retrospective Study of Patients Presenting With Inflammatory Bowel Disease to a Community Hospital

Amakye¹,

Kesiena²,

Ademiluyi³

et al. 2022

Cureus

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“…This improvement in functional activity we identified in those receiving the proactive pain protocol thus further suggests improved pain-control relative to usual care. Increased step count is also known to reduce the risk of deep vein thrombosis (DVT), depression, and anxiety, which are all known complications of patients admitted for IBD flare 26 , 27 . These exploratory analyses warrant further study.…”

Section: Discussionmentioning

confidence: 99%

A randomized controlled trial of a proactive analgesic protocol demonstrates reduced opioid use among hospitalized adults with inflammatory bowel disease

Berry,

Takakura,

Patel

et al. 2023

Sci Rep

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Most hospitalized patients with inflammatory bowel disease (IBD) experience pain. Despite the known risks associated with opioids in IBD including risk for misuse, overdose, infection, readmission, and even death, opioid use is more prevalent in IBD than any other chronic gastrointestinal condition. Most hospitalized IBD patients receive opioids; however, opioids have not been shown to improve pain during hospitalization. We conducted a randomized controlled trial in hospitalized patients with IBD to evaluate the impact of a proactive opioid-sparing analgesic protocol. Wearable devices measured activity and sleep throughout their hospitalization. Chronic opioid users, post-operative, and pregnant patients were excluded. The primary endpoint was a change in pain scores from admission to discharge. Secondary endpoints included opioid use, functional activity, sleep duration and quality, and length of stay. Of 329 adults with IBD evaluated for eligibility, 33 were enrolled and randomized to the intervention or usual care. Both the intervention and control group demonstrated significant decreases in pain scores from admission to discharge (− 2.6 ± 2.6 vs. − 3.0 ± 3.2). Those randomized to the intervention tended to have lower pain scores than the control group regardless of hospital day (3.02 ± 0.90 vs. 4.29 ± 0.81, p = 0.059), used significantly fewer opioids (daily MME 11.8 ± 15.3 vs. 30.9 ± 42.2, p = 0.027), and had a significantly higher step count by Day 4 (2330 ± 1709 vs. 1050 ± 1214; p = 0.014). There were no differences in sleep duration, sleep quality, readmission, or length-of-stay between the two groups. A proactive analgesic protocol does not result in worsening pain but does significantly reduce opioid-use in hospitalized IBD patients.Clinical trial registration number: NCT03798405 (Registered 10/01/2019).

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“…Globally, inflammatory bowel disease (IBD) is considered as the common chronic inflammatory disorders [1,2] and affecting 84.3 people per 100,000 people [3][4][5]. Inflammatory bowel disease is a chronic inflammatory disorder that can affect the gastrointestinal system, typically affecting both intestines [6].…”

Section: Introductionmentioning

confidence: 99%

Risk of Thrombosis and Mortality in Inflammatory Bowel Disease

Khan¹,

Shah²,

Shaheen³

et al. 2021

PJMHS

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Background and Aim: Inflammatory bowel disease patients are more susceptible to risk of developing thrombosis, which leads to increased morbidity and mortality. The majority of hospitalized patients had venous thrombosis with active disease, but numerous cases occur in outpatient setting. The aim of the present study was to evaluate the risk of thrombosis and mortality in inflammatory bowel disease. Methodology: This cross sectional study was conducted on 218 inflammatory bowel disease patients at the department of Medicine, Pak International Medical College Peshawar and Poonch Medical College / CMH Rawlakot Azad Kashmir for duration of six months from March 2021 to August 2021. Demographic details and thrombosis profile along with ultrasonic and magnetic resonance imaging were investigated. All the patients were enrolled based on confirmed diagnosis of inflammatory bowel disease through histological findings, radiological and endoscopic evidences. Demographic details such as age, gender, and clinical details such as risk factors of thrombosis, smoking history, duration of disease, surgeries and pharmaceutical treatment, family history, and use of contraceptive were all recorded. Inflammatory bowel disease activity was defined based on CRP values and medical impression. Optimized treatment such as infliximab was considered in cases where doses increased to 10 mg/kg or interval reduced to 4-6 weeks whereas adalimumab was considered for interval of 1 week. For data analysis, SPSS version 21 was used. Results: Out of 218 patients, 130 (59.8%) were Crohn’s disease (CD) diagnosed patients and 88 (39.2%) were diagnosed with ulcerative colitis (UC). Females 118 (54%) were prevalent than males 100 (46%) and the average age was 33.6±12.5 years with a mean disease duration of 9.72± 4.75 years. The 130 CD patients disease location was as follows: ileal in 23 (17.7%), colonic in 11 (8.5%), and ileocolonic in 27. (20.8%). The prevalence of upper GI involvement and upper GI restriction was 13 (10%) and 11 (8.5%) respectively. Based on behavior of disease (n=119), the prevalence of non-stricturing, non-penetrating, penetrating, and structuring were 31 (26.1%), 54 (41.4%), and 34 (28.6%) respectively. Out of 88 UC patients, the prevalence of pancolitis, left-sided disease, and proctitis were 55 (62.9%), 19 (21.6%) and 14 (15.9%) respectively. Conclusion: Our study found that preliminary evidence for the higher venous thromboembolism risks in patients with IBD associated with ulcerative colitis, steroid use, and ageing. The findings may help to raise clinician awareness and prevent IBD patients from venous thromboembolic complications. Keywords: IBD, Venous thromboembolism, Risk factors

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Predictors of venous thromboembolism in hospitalized patients with inflammatory bowel disease and colon cancer: A retrospective cohort study

Cited by 10 publications

References 12 publications

Venous Thromboembolism Prophylaxis in Inflammatory Bowel Disease: A Two-year Retrospective Study of Patients Presenting With Inflammatory Bowel Disease to a Community Hospital

Venous Thromboembolism Prophylaxis in Inflammatory Bowel Disease: A Two-year Retrospective Study of Patients Presenting With Inflammatory Bowel Disease to a Community Hospital

A randomized controlled trial of a proactive analgesic protocol demonstrates reduced opioid use among hospitalized adults with inflammatory bowel disease

Risk of Thrombosis and Mortality in Inflammatory Bowel Disease

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