Am J Gastroenterol, 2011
Inflammatory bowel disease (IBD) activity is an independent risk factor for venous thromboembolism (VTE), Canadian researchers say.
Dr. Sanjay K. Murthy and Dr. Geoffrey C. Nguyen, with Mount Sinai Hospital in Toronto, found that six large studies have shown an increased risk of VTE in IBD patients relative to non-IBD patients, with odds ratios ranging from 1.48 to 3.6.
And those results may be underestimates, the two researchers say in their report, published online March 15th in the American Journal of Gastroenterology.
Factors associated with VTEs in this patient population include increasing age, higher comorbidity scores and a diagnosis of ulcerative colitis rather than Crohn's disease, according to the report.
"Emerging evidence also supports the notion that disease activity is an important factor that influences the risk of incurring VTEs among IBD patients," the researchers note. Specifically, one study found a 4.5-fold higher rate of VTEs during acute disease flares when compared with periods of remission.
As for prevention, the potential benefits of anticoagulation may outweigh the risks in these patients, the team advises. The American College of Chest Physicians strongly recommends pharmacological VTE prophylaxis in acutely ill patients with IBD who are hospitalized and bedridden, and sequential compression devices for those with contraindications to anticoagulation.
But the authors note that in an ambulatory (i.e., nonhospitalized) patient with an IBD flare, the risk of VTE is less than half what it is in a hospitalized patient (6.4 vs 13.0 per thousand patient-years). Therefore, they say, even if anticoagulation cut the relative risk of VTE by half in the outpatient setting, you'd have to treat 312 patients to prevent one event.
There are no consensus statements on VTE prophylaxis during flares in ambulatory patients, according to Drs. Murthy and Nguyen. "We would need clear evidence of clinical (benefit) and cost-effectiveness of VTE prophylaxis during ambulatory IBD flares before making any recommendations regarding such a strategy," they write.
"Future challenges will be to conduct large prospective studies to better define prognostic factors of VTEs in IBD patients and long-term outcomes in IBD patients who sustain VTEs, as well as to evaluate preventative and treatment strategies of VTEs in this patient population," the authors conclude.
Inflammatory bowel disease (IBD) activity is an independent risk factor for venous thromboembolism (VTE), Canadian researchers say.
Dr. Sanjay K. Murthy and Dr. Geoffrey C. Nguyen, with Mount Sinai Hospital in Toronto, found that six large studies have shown an increased risk of VTE in IBD patients relative to non-IBD patients, with odds ratios ranging from 1.48 to 3.6.
And those results may be underestimates, the two researchers say in their report, published online March 15th in the American Journal of Gastroenterology.
Factors associated with VTEs in this patient population include increasing age, higher comorbidity scores and a diagnosis of ulcerative colitis rather than Crohn's disease, according to the report.
"Emerging evidence also supports the notion that disease activity is an important factor that influences the risk of incurring VTEs among IBD patients," the researchers note. Specifically, one study found a 4.5-fold higher rate of VTEs during acute disease flares when compared with periods of remission.
As for prevention, the potential benefits of anticoagulation may outweigh the risks in these patients, the team advises. The American College of Chest Physicians strongly recommends pharmacological VTE prophylaxis in acutely ill patients with IBD who are hospitalized and bedridden, and sequential compression devices for those with contraindications to anticoagulation.
But the authors note that in an ambulatory (i.e., nonhospitalized) patient with an IBD flare, the risk of VTE is less than half what it is in a hospitalized patient (6.4 vs 13.0 per thousand patient-years). Therefore, they say, even if anticoagulation cut the relative risk of VTE by half in the outpatient setting, you'd have to treat 312 patients to prevent one event.
There are no consensus statements on VTE prophylaxis during flares in ambulatory patients, according to Drs. Murthy and Nguyen. "We would need clear evidence of clinical (benefit) and cost-effectiveness of VTE prophylaxis during ambulatory IBD flares before making any recommendations regarding such a strategy," they write.
"Future challenges will be to conduct large prospective studies to better define prognostic factors of VTEs in IBD patients and long-term outcomes in IBD patients who sustain VTEs, as well as to evaluate preventative and treatment strategies of VTEs in this patient population," the authors conclude.