Thrombosis in the setting of obesity or inflammatory bowel disease

Abstract

Obesity and inflammatory bowel disease (IBD) are systemic inflammatory disorders that predispose to arterial and venous thrombosis through similar prothrombotic mechanisms. Obesity and IBD are chronic risk factors that lead to a persistently elevated risk of thrombosis, although the thrombotic risk with IBD appears to wax and wane with disease severity. Because of the lack of high-quality evidence to guide management decisions, approaches to the prevention and treatment of thrombosis in patients with obesity or IBD are based on extrapolation from general guidelines for antithrombotic therapy. Obesity alters the pharmacokinetics of some anticoagulant drugs, and IBD patients present the added management challenge of having a high risk of gastrointestinal bleeding while taking anticoagulants. An extended duration of anticoagulant therapy is often recommended for obese or IBD patients with unprovoked venous thromboembolism unless there is a high risk of bleeding, although more data and better biomarkers are needed to determine whether anticoagulation can be safely stopped in a subset of IBD patients during remission of active disease. Most patients with obesity or IBD require thromboprophylaxis in conjunction with hospitalization or surgery, with adjustment of anticoagulant dosing in patients with severe obesity.

Deep vein thrombosis in pediatric patients

“…Other chronic diseases that increase DVT frequency in children are gastrointestinal failure leading to long‐term total parenteral nutrition, inflammatory bowel disease (IBD), and children with renal failure on dialysis . Patients with IBD have an increased thrombosis risk due to increased inflammatory cytokines, upregulation of tissue factor, and impaired fibrinolysis . Diseases that cause immobility, such as spina bifida and quadriplegia have also been shown to lead to increased DVT incidence due to increased venous stasis from inactivity …”

Should We Screen Patients with Unprovoked Venous Thromboembolism for Hyperthyroidism? Report of Several Paradigmatic Clinical Cases from the RIETE Registry

“…According to this defi nition several studies record a nearly 40-50% of unprovoked VTE in real life [5] and according to common thrombotic risk factors suggested by guidelines 2014; yet other clinical conditions are well known as conditions that may predispose for VTE as infl ammatory bowel disease, immunopathological disease and/or connectivitis, nephritic syndrome and others [10][11][12].…”

“…However, the literature does not offer the chance to understand the percentage of other medical condition associated to VTE as minor thrombotic risk factor such as infl ammatory bowel diseases [10], immunopathological disease/connectivitis [11], hormonal disease including hyperthyroidism [17] and so on.…”

“…However, several other clinical conditions may be associated with VTE but, are not usually considered for daily screening as a potential cause of VTE, nor are reported as common cause of VTE in large randomized clinical trials and registries including nephrotic syndrome, infl ammatory bowel disease, connectivitis and others [10][11][12].…”

Coagulopathies and inflammatory diseases: ‘…glimpse of a Snark’

“…IBD is also associated with systemic thromboembolic events [78,79]. The incidence of systemic thromboembolic complications in IBD has been known historically, and described to range between 1.3% [80] and 6.4% [81].…”