Extended thromboprophylaxis following colorectal surgery in patients with inflammatory bowel disease: a comprehensive systematic clinical review

Abstract

Aim Patients with inflammatory bowel disease (IBD) are at increased risk of postoperative venous thromboembolism (VTE) following major abdominal surgery. The pathogenesis is multifactorial and not fully understood. A combination of pathophysiology, patient and surgical risk factors increase the risk of postoperative VTE in these patients. Despite being at increased risk, IBD patients are not regularly prescribed extended pharmacological thromboprophylaxis following colorectal surgery. Currently, there is a paucity of evidence‐based guidelines. Thus, the aim of this review is to evaluate the role of extended pharmacological thromboprophylaxis in IBD patients undergoing colorectal surgery. Method A search of Ovid Medline, EMBASE and PubMed databases was performed. A qualitative analysis was performed using 10 clinical questions developed by colorectal surgeons and a thrombosis haematologist. The Newcastle–Ottawa Scale was utilized to assess the quality of evidence. Results A total of 1229 studies were identified, 38 of which met the final inclusion criteria (37 retrospective, one case–control). Rates of postoperative VTE ranged between 0.6% and 8.9%. Patient‐specific risk factors for postoperative VTE included ulcerative colitis, increased age and obesity. Surgery‐specific risk factors for postoperative VTE included open surgery, emergent surgery and ileostomy creation. Patients with IBD were more frequently at increased risk in the included studies for postoperative VTE than patients with colorectal cancer. The risk of bias assessment demonstrated low risk of bias in patient selection and comparability, with variable risk of bias in reported outcomes. Conclusion There is a lack of evidence regarding the use of extended pharmacological thromboprophylaxis in patients with IBD following colorectal surgery. As these patients are at heightened risk of postoperative VTE, future study and consideration of the use of extended pharmacological thromboprophylaxis is warranted.

Prevalence and Effect of Genetic Risk of Thromboembolic Disease in Inflammatory Bowel Disease

“…IBD-related surgery has previously been reported to be one of the established risk factors of TED in multiple studies, with a higher risk observed in UC cases requiring colectomy than CD-related surgery. [25][26][27][28] The elevated risk of UC-related surgery probably reflects, in part, the higher inflammatory burden, and perhaps this is a population in which an increased understanding of genetic risk might have the largest impact. Importantly, genetic factors remained significant even after adjusting for age at last visit and history of IBD-related surgery (Supplementary Table 4).…”

The incidence of venous thromboembolism in children following colorectal resection for inflammatory bowel disease: A multi-center study

“…It is important to consider the level of active inflammation present when determining whether to prescribe mechanical or chemical VTE prophylaxis to IBD patients undergoing colorectal surgery. Further, the duration of the postoperative proinflammatory, hypercoagulable state is not well-defined in children but has been shown to extend for up to two to six weeks in adults [14,15]. Our data found a median postoperative time of two weeks prior to DVT diagnosis, however there were a number of events that occurred much further out than that.…”

Venous Thromboembolism in Patients with Inflammatory Bowel Disease: The Role of Pharmacological Therapy and Surgery

“…In fact, during the natural course of IBD, most CD patients undergo at least one surgical intervention (both intestinal resection or for perianal disease) and approximately 10% of UC patients undergo colectomy, usually with a subsequent construction of an ileo-anal pouch. However, surgery in IBD patients carries a significant VTE risk, despite adequate prophylaxis implementation [ 52 , 53 ]. In fact, a systematic review including 38 studies reported that the postoperative rates of VTE in IBD patients ranged from 0.6% to 8.9% [ 52 ].…”

“…However, surgery in IBD patients carries a significant VTE risk, despite adequate prophylaxis implementation [ 52 , 53 ]. In fact, a systematic review including 38 studies reported that the postoperative rates of VTE in IBD patients ranged from 0.6% to 8.9% [ 52 ]. The most important patient-specific risk factors for postoperative VTE are UC, increasing age and obesity, whereas surgery-specific risk factors include open surgery, emergent surgery and ileostomy creation [ 52 ].…”

“…In fact, a systematic review including 38 studies reported that the postoperative rates of VTE in IBD patients ranged from 0.6% to 8.9% [ 52 ]. The most important patient-specific risk factors for postoperative VTE are UC, increasing age and obesity, whereas surgery-specific risk factors include open surgery, emergent surgery and ileostomy creation [ 52 ]. Furthermore, a recent retrospective study involving 434 UC patients assessed the risk of portomesenteric venous thrombosis (PMVT) following colectomy [ 54 ].…”