The use of pharmacological prophylaxis against venous thromboembolism in hospitalised patients with severe active ulcerative colitis

Abstract

SUMMARY Background Hospitalised patients with inflammatory bowel disease are 1.5- to 3.5-fold more likely to develop venous thromboembolism compared to controls. Clinical guidelines recommend pharmacological prophylaxis. Aim To determine the rate of pharmacological venous thromboembolism prophylaxis prescription and administration in a cohort of hospitalised patients with severe active ulcerative colitis and to assess predictors of failure to order pharmacological prophylaxis at 24 h. Methods This is a retrospective review of hospitalised patients with severe active ulcerative colitis, identified by ICD-9-CM discharge code 556.x, admitted to a single tertiary care hospital from 1 January 2005 to 31 August 2012. Adequate thromboembolism prophylaxis was defined as an order for low-dose unfractionated heparin two to three times daily, low-molecular weight heparin 40 mg daily or fondaparinux 2.5 mg daily ordered and administered for >80% of the admission. Patient related factors associated with failure to order prophylaxis at 24 h were accessed as secondary outcomes. Results Three hundred and thirty-six patients were hospitalised with severe active ulcerative colitis. Hospitalists had prescribed appropriate pharmacological prophylaxis by 48 h in only 37% of cases. Of these, nurses administered all prescribed doses in 18% of cases. Only 7% of patients (22/304, 95% CI: 5–11%) received adequate pharmacological prophylaxis for >80% of their hospitalisation. Hematochezia (P = 0.002), elevated platelets (P = 0.008), male gender coupled with younger age (P = 0.005) and admission on a biologic (P = 0.03) were associated with failure to order prophylaxis. Conclusion Hospitalised patients admitted with severe active ulcerative colitis are not receiving appropriate pharmacological venous thromboembolism prophylaxis.

The risk of venous thromboembolism during and after hospitalisation in patients with inflammatory bowel disease activity

“…It is recognised that prophylaxis is justified by the size of thromboembolic risk among hospitalised inflammatory bowel disease patients, which leads to widespread acceptance that this should be routine. [5][6][7][8] We demonstrated that the risk of venous thromboembolism is also increased in ambulant inflammatory bowel disease patients, and the risk is higher in periods of bowel inflammation. 9 Our work did not demonstrate any additional period in which prophylaxis may be justified.…”

Thromboembolism in inflammatory bowel disease: results from a prospective, population-based European inception cohort

“…However, in selected patients with additional risk factors, the benefit may possibly outweigh the riskfor instance, ambulant IBD patients with active disease who have had a previous VTE, or who have cancer. We further think that according to guidelines, hospitalized patients who in general is sicker, should have anticoagulation [14]. The role of such complex risk stratification schemes could possibly be elucidated in further research.…”

Comparison of a novel predictor of venous thromboembolic complications in inflammatory bowel disease with current predictors

“…However, a critical issue regarding pharmacologic thromboprophylaxis in IBD is its low rate of implementation in hospitalized patients despite guideline recommendations. Recently, three North American retrospective studies reported an overall pharmacological prophylaxis rate of 37–80% on admission …”