Risk of Thromboembolic Events and Associated Healthcare Costs in Patients with Inflammatory Bowel Disease

Abstract

Introduction: Inflammatory bowel disease (IBD) is associated with greater risk of thromboembolic events (TEs) due to the link between systemic inflammation and hypercoagulability. This study assessed the rates of TEs among patients with IBD versus patients without immune-mediated disease (IMD) and the cost of TEs among patients with IBD in the United States.Methods: This study used the IBM MarketScan Ò Commercial and Medicare Supplemental Databases (2014Databases ( -2018. To assess the incremental rates of TEs (deep vein thrombosis [DVT], pulmonary embolism [PE], ischemic stroke [IS], myocardial infarction [MI]), patients with IBD were matched to patients without IMD. Unadjusted and adjusted incidence rate ratios (IRRs) of TEs were used to compare cohorts. To assess the cost of TEs, patients with IBD with TEs were matched to patients with IBD without TEs. Costs were assessed 30 days and 1 year post index date. Results: There were 34,687 matched pairs included in the rates of TE analyses. Compared to patients without IMD, patients with IBD had greater rates of DVT (adjusted IRR [95% confidence interval] 2.44 [2.00, 2.99]; p \ 0.01) and PE (1.90 [1.42, 2.54]; p \ 0.01). Increased rates were not observed for IS and MI. There were 1885 matched pairs included in the cost of TE analyses. Patients with IBD with TEs incurred greater healthcare costs over 30 days and 1 year versus patients without TEs (adjusted total cost difference: 30 days $20,784; 1 year $44,630; p \ 0.01 for both). Conclusions: Patients with IBD experienced greater rates of DVT and PE compared to patients without IMD; this elevated risk was associated with a substantial economic burden.

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

“…5 A more recent study reported higher rates of deep vein thrombosis (DVT) (adjusted incidence rate ratio [IRR]: 2.44 [95% confidence interval [CI]: 2.00-2.99; p < 0.01) and pulmonary embolism (PE) (IRR: 1.90 [95% CI: 1.42-2.54]; p < 0.01) in patients with IBD. 6 The DVT risk appears to be similar in CD and UC: the reported incidence rate of DVT was 31.4/10,000 personyears and that of PE was 10.3/10,000 person-years in CD versus 30.0/10,000 person-years and 19.8/10,000 personyears in UC, respectively 4 (►Table 1).…”

“…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.…”

“…12,13 Furthermore, VTE occurrence in patients with IBD increases hospitalization costs. 6 IBD was shown to be an independent risk factor for VTE recurrence (hazard ratio [HR]: 2.5 [95% CI: 1.4-4.2; p ¼ 0.001). 14 Indeed, the likelihood of recurrence 5 years after discontinuation of anticoagulation therapy was significantly higher among IBD patients (33.4% [95% CI: 21.8-45.0) versus patients without IBD (21.7% [95% CI: 18.8-24.6; p ¼ 0.01).…”

The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Reduction of Venous Thromboembolic Disease in Colorectal Surgery

“…1 Interestingly, the reported risk of VTE is also high in certain otherwise benign conditions; patients with IBD have a 2-to 3-fold increased risk of DVT and pulmonary embolism (PE) compared with the general population. 20 In hospitalized patients with IBD, the overall risk of VTE has been reported to be 4.3%. [21][22][23][24] In a cohort study of 80,445 hospital discharges of patients with IBD, the cumulative rate of VTE at 12 months was 2.1% for patients with Crohn's disease (CD; 1.2% for surgical patients and 2.4% for nonsurgical patients; p < 0.001) and 2.0% for patients with ulcerative colitis (UC; 2.2% for surgical patients and 2.0% for nonsurgical patients; p = 0.32).…”

Effects of Olive Oil and Its Components on Intestinal Inflammation and Inflammatory Bowel Disease

“…Nevertheless, as a substantial amount of accumulated data suggests the safety and, to some extent, the beneficial effects of olive oil, it is well-justified to perform randomized trials that would confirm these effects and establish the appropriate dosage/type of olive oil in IBD treatment. An especially interesting aspect would be to determine the benefits, if there are any, of olive oil in the primary and secondary prevention of cardiovascular repercussions, as IBD patients are burdened by increased risk for atherosclerotic cardiovascular disease and venous thromboembolism [80,81].…”