NEW YORK (Reuters Health) – The rate of deep vein thrombosis or pulmonary embolism is twice as high among surgical patients in the US with inflammatory bowel disease (IBD) than those without, according to an analysis of national data reported in the Archives of Surgery online October 17.
The risk of deep vein thrombosis (DVT) or pulmonary embolism (PE) is even higher for IBD patients undergoing non-intestinal surgery, they authors found. “Perhaps standards for DVT and PE prophylaxis in these cases should be reconsidered,” they say.
Dr. Frederick Millham at Newton Wellesley Hospital, Massachusetts, and Dr. Andrea Merrill with Massachusetts General Hospital, Boston point out that it has been recognized for 75 years that IBD patients are at increased risk for thromboembolic events, but standard prophylaxis guidelines do not recommend special measures for this population. Furthermore, recent data suggest a very high risk of DVT among patients with IBD who require surgery.
To investigate, the researchers examined data on 271,368 patients in the National Surgical Quality Improvement Program, which collects data from more than 200 participating hospitals around the country. Within this cohort, 2249 patients (0.8%) had a diagnosis of IBD.
Drs. Merrill and Millham found that 2.5% of the IBD patients had DVT or PE, compared with 1.0% of patients without IBD (p<0.001). After controlling for numerous confounders, IBD remained a significant predictor of DVT or PE (OR=2.03).
Among the IBD group, 100 patients had procedures that were not on the small or large intestine, and 5% of this subset had DVT or PE, according to the report. This translated to an odds ratio of 4.45 for DVT/PE compared to patients without IBD.
However, contrary to previous reports, thromboembolic events were no more lethal than normal for IBD patients. Mortality among patients with DVT/PE was 8.6% in those without IBD versus 8.8% in those with IBD (p>0.99).
Summing up, the authors conclude, “Patients with IBD who undergo surgery have a 2-fold increased risk of DVT or PE. In patients with IBD who are having nonintestinal surgery, this risk may be even higher.”
They add, “These findings suggest that standard DVT and PE prophylaxis should be reconsidered for this patient group.”
Arch Surg 2011.
