Persistently High Rate of Venous Thromboembolic Disease in Inflammatory Bowel Disease: A Population-Based Study

Abstract

INTRODUCTION: Venous thromboembolism (VTE) is known to be increased in inflammatory bowel disease (IBD). We aimed to determine whether rates of VTE in IBD have reduced over the past 30 years. METHODS: We used the population-based University of Manitoba IBD Epidemiology Database (1984–2018) to determine the incidence of VTE in IBD and the incidence rate ratio vs matched controls. In persons with IBD with and without VTE, we assessed for variables that were associated with an increased risk of VTE on multivariate logistic regression. RESULTS: The incidence of VTE in the IBD cohort was 7.6% which was significantly greater than in controls (3.3%, P < 0.0001). The overall age-standardized incidence rate of VTE was 433 per 100,000 in IBD and 184 per 100,000 in controls. The incidence of VTE was higher in Crohn's disease (8.4%) than in ulcerative colitis (6.9%, P = 0.0028). The incidence rate ratio in IBD vs controls was 2.36 (95% confidence interval 2.16–2.58). The increased risk was similar in males and females and in Crohn's disease compared with ulcerative colitis. The incidence rate among persons with IBD from 1985 to 2018 decreased very slowly, with annual percent change of −0.7% (P = 0.0003). Hospital admission, high comorbidity, use of antibodies to tumor necrosis factor for less than 3 years up until the time of the VTE, and the combination of steroid and antibodies to tumor necrosis factor increased the risk of VTE. DISCUSSION: Despite advancements in IBD management in the past 30 years, the rates of VTE have only been slowly decreasing and remain significantly increased compared with controls.

Increasing rates of venous thromboembolism among hospitalised patients with inflammatory bowel disease: a nationwide analysis

“…In addition to the high rate of morbidity associated with VTE, as well as the large economic burden, prior data have shown an increased risk of mortality as a result of VTE 34 . In our study, we found that among all patients hospitalised with IBD, the presence of a VTE increased the odds of mortality by more than twofold, which is similar to findings from the Manitoba cohort 14 . Furthermore, individuals who had a VTE during hospitalisation had a higher risk of mortality if they were older (>80 years old), male, had colorectal surgery or flexible sigmoidoscopy/colonoscopy during hospitalisation, or had Clostridioides difficile .…”

“…In our study, despite advances in medical knowledge, and increasing awareness of the risk of VTE in IBD as highlighted in the 2014 Canadian Association of Gastroenterology's consensus statement, we found that the rate of VTE among all hospitalised patients with IBD significantly increased from the years 2000 to 2018 30 . Despite publication of these guidelines, prior data from Manitoba suggest similar findings, noting a persistently high rate of VTE among patients with IBD 14 . When restricting our analysis to only include admissions from the ER with a primary indication of IBD, although the rates of VTE did not increase, they remained persistently elevated over time.…”

“…This, in addition to studies showing stable to slower increases in VTE rates among the general population, further support this notion and decrease the likelihood that our findings are attributable to an overall increased recognition, diagnosis or coding of VTE. 14,49 However, it is still possible, that our findings may in part be the result of an increasing ascertainment of minor VTE events over time.…”

Vaccination against SARS-CoV-2 in Patients with Inflammatory Bowel Diseases: Where Do We Stand?

“…Given the theoretical risk of suboptimal immune responses on the one hand and an apparently higher effectiveness of mRNA-based vaccines, there could be a rationale for a preferred use of these vaccines in IBD patients. Additionally, IBD patients are typically of a younger age and carry an increased risk for venous thromboembolism due to their underlying disease [40][41][42]. After the approval of the vector vaccines ChAdOx1 and Ad26.CoV2.S and application to millions of people, rare but significantly increased cases of cerebral thrombosis were detected especially in recipients of a younger age, while this was not the case after vaccination with mRNA vaccines [43,44].…”

Endothelial Dysfunction and Arterial Stiffness in Patients with Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis

“…Indeed, patients with chronic inflammatory diseases, such as systemic lupus erythematosus, rheumatoid arthritis, and psoriasis, have an increased risk of arterial and venous thromboembolic events [ 4 ]. Population-based studies have also suggested that patients with inflammatory bowel disease (IBD), including ulcerative colitis (UC) and Crohn’s disease (CD), might be at an increased risk for CVDs, including coronary artery disease (CAD) and arterial and venous thromboembolic events [ 5 , 6 , 7 , 8 ].…”