Risk Factors of Venous Thromboembolism in Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis

Abstract

Background: Patients suffering from chronic inflammatory disorders, such as inflammatory bowel disorder, are at higher risk of developing thromboembolism. The chronic inflammatory nature of inflammatory bowel disease has been identified as a predominant reason for a state of Virchow's triad (i.e., endothelial dysfunction, stasis, and general hypercoagulability), eventually leading to the onset of venous thromboembolism. Recent studies show that certain factors, such as demographics, medication history, and history of surgical intervention may increase thromboembolism risk in patients with inflammatory bowel disease. However, to date, no study has attempted to evaluate the effect of different risk factors associated with the development of venous thromboembolism in inflammatory bowel disease patients.Objective: To evaluate the risk factors that can influence the incidence of venous thromboembolism in patients with inflammatory bowel disease.Methods: Academic literature was systematically searched based on the PRISMA guidelines across five databases: Web of Science, EMBASE, CENTRAL, Scopus, and MEDLINE. A random-effect meta-analysis was conducted to evaluate the hazard ratio for the risk factors (i.e., aging, gender, steroid therapy, surgery, and ulcerative colitis) that can influence the incidence of venous thromboembolism in patients with inflammatory bowel disease.Results: From a total of 963 studies, 18 eligible studies with 1,062,985 (44.59 ± 10.18 years) patients suffering from inflammatory bowel disease were included in the review. A meta-analysis revealed a higher risk of aging (Hazard's ratio: 2.19), steroids (1.87), surgery (1.48), and ulcerative colitis (2.06) on venous thromboembolism in patients with inflammatory bowel disease. We also found that the female gender (0.92) did not increase the incidence of venous thromboembolism in inflammatory bowel disease patients.Conclusion: The study provides preliminary evidence regarding high risks associated with ulcerative colitis, steroid consumption, and aging for the development of venous thromboembolism in patients with inflammatory bowel disease. The findings from this study may contribute to developing awareness among clinicians, better risk stratification and prevention of venous thromboembolic complications in patients with inflammatory bowel disease.

Occurrence of Thromboembolism in Paediatric Patients With Inflammatory Bowel Disease: Data From the CEDATA-GPGE Registry

“…Not only complications like fistulas or strictures are associated with an increased risk, but especially pancolonic involvement in UC and colonic involvement in CD (26), a notion further substantiated by our findings, since all patients affected had colonic involvement. There was no statistically significant difference in rates between girls and boys (29).…”

“…Based on US in-patient data by means of an aggregated, stratified random sample across five time periods, Nylund et al (25) Inflammatory bowel disease per se is an acknowledged risk factor with pathogenic and clinical specifics accountable for increased TE events, as shown in adult patients with an Odds Ratio of 1.85 [1.7-2.01] in UC and 1.48 [1.35-11.62] in CD, resulting in excess mortality of 2.1-fold compared with patients without IBD (26). The risk seems to multiply during moderate to severe flares with a hazard ratio of 4-8 (27), wherein patients with IBD in active disease sharing, for example, thrombocytosis as a significant trigger of TE (28), and especially those < 40 years having a higher risk of cardiovascular disease (29).…”

Inflammatory bowel disease and thromboembolic events: a c’lot to learn

“…However, factors like fluid depletion or prolonged immobilization can affect the haemostatic system during hospitalization, contributing to the finding that hospitalization and surgery are associated with a higher probability of TE regardless of disease activity or the reason of admission. 18 , 24 , 29 According to ECCO guidelines, subcutaneous prophylactic heparin or low molecular weight heparin is indicated to reduce the likeliness of venous TE; prophylactic TE treatment should be withheld only in patients with severe lower intestinal bleeding. 30 However, some studies report that thromboprophylaxis rates among hospitalized patients, particularly in medical services, are low.…”

Editorial: is older‐onset ulcerative colitis more severe or less aggressively managed?

“…Importantly, age, comorbidities and active UC are also independent risk factors for thrombosis and infection. 6,7 These findings are thought-provoking, with the potential to alter the management of older-onset UC, although further substantiation, ideally with prospective data, would be valuable. The existing treatment paradigms should be adapted to the older population, although given the evidence of increased infective complications with anti-TNF agents and calcineurin inhibitors, 1 corticosteroids are likely to remain the mainstay of treatment of moderate to severe flares.…”

“…More adverse events occurred in the older‐onset group, namely infectious (18.1% vs 8.6%) and thrombotic complications (7.2% vs 0.5%), despite less immunosuppressant use. Importantly, age, comorbidities and active UC are also independent risk factors for thrombosis and infection 6,7 …”