This risk factor includes regional ileitis, ulcerative colitis, and not irritable bowel syndrome. Patients with inactive as well as active
DiseaseElevated Venous Thromboembolism Risk Following Colectomy for IBD Is Equal to Those for Colorectal Cancer for Ninety Days After Surgery
Fadwa Ali 1, Sadeer G Al-Kindi 2, Jacqueline J Blank 1, Carrie Y Peterson 3, Kirk A Ludwig 3, Timothy J Ridolfi 3
PMID: 29420429. DOI: 10.1097/DCR.0000000000001036
Abstract
Background: The risk of postoperative venous thromboembolism is high in patients with colon cancer and IBD. Although The American Society of Colon and Rectal Surgeons suggests posthospital prophylaxis after surgery in patients with colon cancer, there are no such recommendations for patients with IBD.
Objective: This study aims to analyze the incidence and risk factors for postoperative venous thromboembolism.
Design: This was a retrospective review using the Explorys platform.
Settings: Aggregated electronic medical records from 26 major health care systems across the United States from 1999 to 2017 were used for this study.
Patients: Patients who underwent colon surgery were included.
Main outcome measures: Patients were followed up to 90 days postoperatively for deep vein thrombosis and pulmonary embolism.
Results: A total of 75,620 patients underwent colon resections, including 32,020 patients with colon cancer, 9850 patients with IBD, and 33,750 patients with diverticulitis. The 30-day incidence of venous thromboembolism was higher in patients with cancer and IBD than in patients with diverticulitis (2.9%, 3.1%, and 2.4%, p < 0.001 for both comparisons). The 30-day incidence of venous thromboembolism in patients with ulcerative colitis is greater than in patients with Crohn’s disease (4.1% vs 2.1%, p < 0.001). The cumulative incidence of venous thromboembolism increased from 1.2% at 7 days after surgery to 4.3% at 90 days after surgery in patients with cancer, and from 1.3% to 4.3% in patients with IBD. In multivariable analysis, increase in the risk of venous thromboembolism was associated with cancer diagnosis, IBD diagnosis, age ≥60, smoking, and obesity.
Limitations: This study was limited by its retrospective nature and by the use of the aggregated electronic database, which is based on charted codes and contains only limited collateral clinical data.
Conclusions: Because of the elevated and sustained risk of postoperative thromboembolism, patients with IBD, especially ulcerative colitis, might benefit from extended thromboembolism prophylaxis similar to that of patients with colon cancer. See Video Abstract at http://links.lww.com/DCR/A544.
Reference:
Dis Colon Rectum. 2018 Mar;61(3):375-381. doi: 10.1097/DCR.0000000000001036.
The risk of venous thromboembolism during and after hospitalisation in patients with inflammatory bowel disease activity
Thomas P C Chu 1, Matthew J Grainge 1, Timothy R Card 1 2
PMID: 30294897. DOI: 10.1111/apt.15010
Abstract
Background: Inflammatory bowel disease (IBD) increases the risk of venous thromboembolism.
Aims: To determine when patients are at high risk of thromboembolic events, including after major surgery, and to guide timing of thromboprophylaxis.
Methods: Each IBD patient from Clinical Practice Research Datalink, linked with Hospital Episode Statistics, was matched to up to five non-IBD patients in this cohort study. We examined their risk of thromboembolism in hospital and within 6 weeks after leaving hospital, with or without undergoing major surgery, and while ambulant. Hazard ratios were estimated using Cox regression, with adjustment for age, sex, body mass index, smoking and history of malignancy or thromboembolism.
Results: Overall 23 046 IBD patients had a thromboembolic risk 1.74-times (95% CI = 1.55-1.96) higher than 106 795 non-IBD patients. Among ambulant patients, the thromboembolic risk was raised during acute (hazard ratio = 3.94, 2.79-5.57) or chronic disease activity (3.97, 2.90-5.45) but their absolute risk remained below 5/1000 person-years. The hazard ratio for thromboembolism among in-patients not undergoing major surgery was 1.13 (0.63-2.02), compared to 2.43 (1.20-4.92) among surgical patients, with a near doubling of absolute risk associated with surgery (59.5/1000 person-years, compared with 31.1 without surgery). The absolute risk remained elevated within 6 weeks after leaving hospital (18.6/1000 person-years in IBD patients after surgery).
Conclusions: IBD patients are at an increased risk of venous thromboembolism. Absolute risks are raised during active disease, when in hospital, and after leaving hospital following major surgery.
Reference:
Aliment Pharmacol Ther. 2018 Nov;48(10):1099-1108. doi: 10.1111/apt.15010. Epub 2018 Oct 8