NEW YORK (Reuters Health) – Inflammatory bowel disease (IBD) activity is an independent risk factor for the development of venous thromboembolic events (VTEs). That’s one of the findings of an epidemiological review published in the Americal Journal of Gastroenterology online March 15.
Dr. Sanjay K. Murthy and Dr. Geoffrey C. Nguyen, with Mount Sinai Hospital, University of Toronto, Ontario, Canada say their review summarizes information regarding the epidemiology of VTEs in IBD patients, “and offers some perspectives for patient care in this patient population.”
The team 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.
However, several of the studies may not have fully captured all VTE cases in IBD patients. “Therefore, large prospective studies with long-term follow-up and similar outcome assessment strategies in IBD and non-IBD patients are required to ascertain accurate and unbiased estimates of the absolute and relative rates of VTEs in IBD patients,” the authors suggest.
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 admitted to hospital and confined to a bed, and sequential compression devices for those with contraindications to anticoagulation.
However, “There are no consensus statements that address implementation of VTE prophylaxis during flares in the ambulatory setting,” Drs. Murthy and Nguyen report.
They conclude: “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.”
Venous Thromboembolism in Inflammatory Bowel Disease: An Epidemiological Review
Am J Gastroenterol 2011.