The risk of venous thromboembolic events in patients with inflammatory bowel disease: a systematic review and meta-analysis

Abstract

Background Inflammatory bowel disease (IBD), comprising Crohn’s disease (CD) and ulcerative colitis (UC), is a chronic inflammatory disorder of the gastrointestinal tract that has been associated with increased risk of extraintestinal manifestations, amongst which is venous thromboembolism (VTE). We assessed the risk for VTE in patients with IBD through systematic review and meta-analysis. Methods A systematic search for English language studies was conducted in Medline, Scopus, and the Cochrane Library of publications from database inception till August 10, 2020, to identify relevant studies reporting the risk of VTE in patients with IBD. The random-effects and fixed-effect models were used to estimate relative risks (RRs) with their respective 95% confidence intervals (CIs). The quality of the included studies was assessed using the Newcastle-Ottawa scale. Results Eleven observational studies were included in this meta-analysis, involving 3,175,012 patients with IBD and 920,144,253 controls without IBD. The overall RR for VTE in patients with IBD compared to non-IBD individuals was 2.03 (95%CI 1.72-2.39). An analysis of studies with larger population size demonstrated a lower risk for VTE (RR 1.77, 95%CI 1.48-2.13) among patients with IBD, whereas studies with a smaller population size yielded a greater risk for VTE (RR 2.67, 95%CI 1.97-2.93). After adjustment for smoking and body mass index, the RR for VTE was moderately increased (RR 2.65, 95%CI 1.51-4.65). Conclusions The present meta-analysis shows that IBD is linked to a 2-fold increased risk for VTE. Thus, primary prevention against VTE is of the utmost importance.

Immune-mediated inflammatory diseases and risk of venous thromboembolism: A Mendelian randomization study

“…The IBD GWAS dataset used in this study combines UC and CD, whereby we performed separate MR analyses on total IBD, UC, and CD. Unlike previous studies which reported that the risk of VTE was increased in both CD and UC patients (35)(36)(37), the MR evidence provided by this study only showed a causal relationship between UC and VTE. Notably, the meta-analysis results published by Fumery, M et al showed a significantly higher risk of VTE in UC inpatients than in CD inpatients (P = 0.0029) (14), which together with our findings suggested that UC patients may have a greater risk of VTE compared with CD patients.…”

“…The IBD GWAS dataset used in this study combines UC and CD, whereby we performed separate MR analyses on total IBD, UC, and CD. Unlike previous studies which reported that the risk of VTE was increased in both CD and UC patients ( 35 – 37 ), the MR evidence provided by this study only showed a causal relationship between UC and VTE. Notably, the meta-analysis results published by Fumery, M et al.…”

“…Furthermore, two recent cohort studies based on Asian populations reported that IBD patients are 1.80-, 1.98- and 2-fold more likely to develop PE, DVT ( 35 ), and VTE ( 36 ), respectively. A meta-analysis summarizing data from 11 observational studies covering 3,175,012 IBD patients and 920,144,253 controls showed an RR of 2.03 (95% CI: 1.72-2.39) for the occurrence of VTE in the former group ( 37 ). However, these observational studies reported significant heterogeneity, as demonstrated by stratified analysis based on sample size showing lower VTE risk in larger samples (RR 1.77, 95% CI 1.48-2.13 in large sample size studies; versus RR 2.67, 95% CI 1.97-2.93 in smaller sample sizes).…”

The Demographic Data and Prevalence of Thromboembolic Events Among Inflammatory Bowel Disease Patients in Buraydah, Al-Qassim Region

“…The prevalence of thromboembolic events among IBD patients was found to be 1.1%, mostly in the interval resolution middle and left portal vein and inferior mesenteric vein. The thromboembolic events noted were thrombosis (0.5%) and DVT (0.5%), and similar findings were reported in the parallel study conducted by Arvanitakis et al, in which the prevalence was found to be between 1.3% and 7.7% [11]. Also, one congruent study reported a similar prevalence [8].…”

Evaluation of adalimumab effects on left ventricle performance by echocardiography indexes among patients with immunosuppressant refractory ulcerative colitis

“…First, increased cellular attachment to the vascular inner surface, in addition to the provoked hypercoagulable state in the setting of IBD (37), induces or accelerates atherosclerosis and ultimately results in a higher risk of thrombosis events (38). Arvanitakis et al, in a recent meta-analysis, exposing the 2-fold increased risk of venous thromboembolism in patients with IBD, emphasized prophylaxis and primary prevention importance (39). Second, a thrombus formation interceded by atrial fibrillation during the active phase of IBD was illustrated by Kristensen et al (40).…”