Venous Thromboembolism in Patients with Inflammatory Bowel Diseases

Abstract

Introduction Inflammatory bowel disease is a well known risk factor for venous thromboembolism (VTE). Existing guidelines for thromboprophylaxis in hospitalized patients do not extend to other clinical scenarios that may also be associated with VTE risk. Our aim was to estimate the fraction of VTE events in IBD patients that could be prevented. Methods A retrospective analysis assessed all IBD patients diagnosed with VTE at a single academic medical center from 2002–2012. Confirmed cases were analyzed for VTE risk factors, inpatient status, the use of DVT prophylaxis, and when applicable the reason for omission of prophylaxis. IBD VTE cases were compared with age- and sex-matched non-IBD VTE controls with regards to risk factors and potential opportunities for VTE prevention. Results There were 204 IBD patients (108 UC, 96 CD) diagnosed with VTE (110 DVT, 66 PE, 27 intra-abdominal thromboses, 1 other). One third of the VTE events occurred in hospitalized patients. Two-third of the medical inpatients and 44% of surgical in-patients who developed VTE did not receive prophylaxis. Importantly, 129 VTE events occurred in outpatients. The proportion of outpatients hospitalized within 4 weeks of developing venous thrombosis was higher in IBD patients than non-IBD controls (33 vs. 15%, p=0.0003). One-third of patients (36%) were experiencing ambulatory disease flares at the time of VTE diagnosis. Conclusions A substantial portion of VTE events in IBD patients occurred in clinical scenarios not routinely recommended for thromboprophylaxis. Further investigation of primary prophylaxis for IBD patients in high risk outpatients may be warranted.

The Changing Phenotype of Inflammatory Bowel Disease

“…Patients with IBD are at increased risk of developing VTE upon hospital discharge compared with other patients [58]. The inflammatory cascade that increases risk of VTE likely also places patients with IBD at increased risk of heart failure [59] and atrial fibrillation [60] during periods of disease activity.…”

Association between small intestinal bacterial overgrowth and deep vein thrombosis

“…DVT occurs most often in the calf or thighs but can also originate in the proximal veins and is the primary cause of pulmonary thromboembolism [6]. Several diseases such as IBD and chronic kidney disease (CKD) have been implicated in the development of DVT, mainly by changes in coagulation factors and the production of pro-inflammatory mediators [7–9]. …”

Steroid but not Biological Therapy Elevates the risk of Venous Thromboembolic Events in Inflammatory Bowel Disease: A Meta-Analysis

“…At least four relevant studies were excluded due to unavailable ORs of VTE risk. 42,51,52 In the study of Scoville et al, 53 there were non-IBD VTE controls as comparators for VTE risk in IBD, which did not match the control group criteria in our meta-analysis. Additionally, we cannot rule out that we lost relevant articles by having imposed English language, as a filter, on the search.…”