Minor Hematochezia Decreases Use of Venous Thromboembolism Prophylaxis in Patients with Inflammatory Bowel Disease

Abstract

Background Despite increased risk of venous thromboembolism (VTE) among hospitalized patients with inflammatory bowel disease (IBD), pharmacologic prophylaxis rates remain low. We sought to understand the reasons for this by assessing factors associated with VTE prophylaxis in patients with IBD and the safety of its use. Methods This was a retrospective cohort study conducted among patients hospitalized between January 2013 and August 2018. The primary outcome was VTE prophylaxis, and exposures of interest included acute and chronic bleeding. Medical records were parsed electronically for covariables, and logistic regression was used to assess factors associated with VTE prophylaxis. Results There were 22,499 patients studied, including 474 (2%) with IBD. Patients with IBD were less likely to be placed on VTE prophylaxis (79% with IBD, 87% without IBD), particularly if hematochezia was present (57% with hematochezia, 86% without hematochezia). Among patients with IBD, admission to a medical service and hematochezia (adjusted odds ratio 0.27; 95% CI, 0.16–0.46) were among the strongest independent predictors of decreased VTE prophylaxis use. Neither hematochezia nor VTE prophylaxis was associated with increased blood transfusion rates or with a clinically significant decline in hemoglobin level during hospitalization. Conclusion Hospitalized patients are less likely to be placed on VTE prophylaxis if they have IBD, and hematochezia may drive this. Hematochezia appeared to be minor and was unaffected by VTE prophylaxis. Education related to the safety of VTE prophylaxis in the setting of minor hematochezia may be a high-yield way to increase VTE prophylaxis rates in patients with IBD.

Incidence and risk factors for venous thrombosis among patients with inflammatory bowel disease in China: a multicenter retrospective study

“…18 Many factors influence the cost-effectiveness of thromboprophylaxis, including incidence of venous thrombosis, the benefits of prophylaxis against risk of bleeding in different patient subgroups, and also socio-economic factors such as cost and compliance. 19,20 For patients in Asia, due to lower incidence of venous thrombosis in general and different socio-economic backgrounds, precise risk stratification models are needed. This would require incidence and risk factor studies among different patient subgroups, and also investigations into risk and benefits of thromboprophylaxis among Asian IBD patients.…”

“…Therefore, standardized protocols for thromboprophylaxis for IBD patients in Asia are necessary, especially for patients with additional risks for venous thrombosis [ 18 ]. Many factors influence the cost-effectiveness of thromboprophylaxis, including incidence of venous thrombosis, the benefits of prophylaxis against risk of bleeding in different patient subgroups, and also socio-economic factors such as cost and compliance [ 19 , 20 ]. For patients in Asia, due to lower incidence of venous thrombosis in general and different socio-economic backgrounds, precise risk stratification models are needed.…”

Cerebral Venous Sinus Thrombosis in Patients With Inflammatory Bowel Disease: A Retrospective Study

“…For IBD patients with high risk of CVST, prophylactic anticoagulation with heparin or low molecular weight heparin might decrease risk and mortality rates even in IBD patients complicated with CVST [8] . Besides, study also showed prophylaxis of thrombosis for IBD patients was safe and should be recommended [18][19][20] .…”

Inflammatory Bowel Disease and Thrombosis: A National Inpatient Sample Study

“…Thromboprophylaxis is typically avoided in patients with IBD due to concerns regarding GI tract bleeding. 26 Despite this, anticoagulation prophylaxis has been shown to be safe in IBD patients, with no greater bleeding than in non-IBD patients. 18,26,27 Further, it has been recommended that anticoagulation should be extended beyond acute thrombosis and/or hospitalization, 18,28,29 especially in those with frequent flares and chronic steroid use.…”

“…26 Despite this, anticoagulation prophylaxis has been shown to be safe in IBD patients, with no greater bleeding than in non-IBD patients. 18,26,27 Further, it has been recommended that anticoagulation should be extended beyond acute thrombosis and/or hospitalization, 18,28,29 especially in those with frequent flares and chronic steroid use. 17,18,30,31 Our findings indicate that thrombosis risk exists in other subsets of IBD patients, that is, those using ports and undergoing general and abdominal surgery.…”