Inflammatory Bowel Disease and Thrombosis: A National Inpatient Sample Study

Abstract

Introduction Thrombosis is more common in inflammatory bowel disease (IBD) patients than the general population, but disease-specific correlates of thrombosis remain unclear. Methods We performed a retrospective analysis of discharge data from the National Inpatient Sample between 2009 and 2014, using International Disease Classification codes to identify IBD and non-IBD patients with or without thrombosis. We used NIS-provided discharge-level weights to reflect prevalence estimates. Categoric variables were analyzed by Rao-Scott Chi-square test, continuous variables by weighted simple linear regression, and covariates associated with thrombosis by weighted multivariable logistic regression. Results Thrombosis prevalence in IBD was significantly greater than in non-IBD, 7.52 versus 4.54%, p < 0.0001. IBD patients with thrombosis were older and more likely to be Caucasian than IBD without thrombosis, each p < 0.001. Thrombosis occurred most commonly in the mesenteric vein. Thrombotic risk factors in IBD include surgery, ports, malignancy, dehydration, malnutrition, and steroids at 53.7, 13.2, 13.1, 12.4, 8.9, and 8.2%, respectively. Those with thrombosis had greater severity of illness, 1.42 versus 0.96; length of stay, 7.7 versus 5.5 days; and mortality, 3.8 versus 1.5%; all p < 0.0001. Adjusting for age and comorbidity, odds ratios for predictors of thrombosis included ports, steroids, malnutrition, and malignancy at 1.73, 1.61, 1.34, and 1.13, respectively, while Asian race, 0.61, was protective, each p < 0.001. Conclusion Thrombosis prevalence is 1.7-fold greater in IBD than non-IBD patients. Adjusting for age and comorbidity, the odds ratio for thrombosis in IBD was 73% higher with ports, 61% higher with steroids, 34% with malnutrition, and 13% with malignancy. Whether long-term anticoagulation would benefit the latter is unknown.

Micronutrient Absorption and Related Outcomes in People with Inflammatory Bowel Disease: A Review

“…Homocysteine also promotes the secretion of pro-inflammatory chemokines, and the differentiation of naïve CD4+ T cells into pro-inflammatory T H 17 cells [46]. Homocysteine levels are correlated with thrombotic events, and interestingly, IBD patients have an increased prevalence of thrombosis compared to those without IBD (5-year prevalence, 7.5% vs. 4.5%, p < 0.001) [47]. Furthermore, the patients are at increased risk of mesenteric ischemia (HR 11.2), and female IBD patients have significantly higher risk of MI (HR 1.6) and stroke (HR 2.1) [48].…”

Cerebral Venous Sinus Thrombosis is a Reversible Complication of Ulcerative Colitis

“…Bargen et al first reported an association between venous thromboembolism and IBD in 1936 [7]. In IBD, the incidence of CVST ranges from 0.5% to 6.7% [5], and it is relatively more common in ulcerative colitis than in Crohn's disease [8]. Up to half of all patients with ulcerative colitis will develop extraintestinal manifestations, typically about 15 years after the initial diagnosis [1,2].…”

Aktualisierte S3-Leitlinie „Diagnostik und Therapie des Morbus Crohn“ der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS) – August 2021 – AWMF-Registernummer: 021-004

“…Das Risiko für thrombembolische Ereignisse bei erwachsenen Patient*innen mit CED ist deutlich erhöht (8,4fach im Vergleich zur Normalbevölkerung) [670,671] und bei Erwachsenen mit einer 8fach erhöhten Mortalität assoziiert [672]. Neben den allgemeinen Risikofaktoren für thrombembolische Ereignisse sind wichtige CEDspezifische Risikofaktoren die chirurgische Therapie, eine hohe Krankheitsaktivität, das Vorhandensein eines Ports, eine Mangelernährung und eine Dehydration [673]. Bei hospitalisierten Patient*innen sind thrombembolische Ereignisse deutlich häufiger als bei ambulanten Patient*innen, allerdings ist auch das Thromboserisiko der nicht hospitalisierten Patient*innen gegenüber der Referenzpopulation signifikant erhöht [670].…”