Survey of Perceptions and Practices among Canadian Gastroenterologists regarding the Prevention of Venous Thromboembolism for Hospitalized Inflammatory Bowel Disease Patients

Abstract

There was a general consensus among academic gastroenterologists that IBD inpatients are at an increased risk for VTE and would benefit from VTE prophylaxis. However, areas of uncertainty still exist and the IBD community would benefit from evidence-based clinical practice guidelines to standardize the management of this important problem.

Review article: the practical management of acute severe ulcerative colitis

“…Low molecular weight heparin and fondaparinux have been shown to significantly reduce VTE risk in hospitalised patients . Despite the latter evidence, surveys indicate that up to 65% of gastroenterologists fail to administer VTE prophylaxis to patients admitted for ASUC . Thromboprophylaxis does not appear to precipitate excessive bleeding during flares of IBD, even in patients experiencing bloody diarrhoea, and is recommended in all patients with ASUC .…”

“…149 Despite the latter evidence, surveys indicate that up to 65% of gastroenterologists fail to administer VTE prophylaxis to patients admitted for ASUC. [150][151][152] Thromboprophylaxis does not appear to precipitate excessive bleeding during flares of IBD, even in patients experiencing bloody diarrhoea, and is recommended in all patients with ASUC. 153,154 The VTE risk in IBD patients appears to be highest in ambulant out-patients following discharge from hospital (HR 15.8; 95% CI: 9.8-25.5, P < 0.0001), suggesting that there may be a role for maintaining prophylaxis in the out-patient setting.…”

Defining Quality Indicators for Best-Practice Management of Inflammatory Bowel Disease in Canada

“…Despite evidence supporting an increased risk for VTE and its associated morbidity and mortality in IBD patients, there is significant variation in practice for VTE prophylaxis among gastroenterologists (16,17). A recent United States medical and drug insurance claims database review indicated that fewer than one-third of hospitalized IBD patients receive prophylactic anticoagulants (18).…”

Challenging Question: Is Treating Inflammatory Bowel Disease an Art or Strictly an Evidence-Based Matter?

“…Several recent surveys document that management by IBD specialists differs widely, even when level 1 evidence, endorsed by national or international treatment guidelines, exists for a specific clinical problem. For example, a large variation exists in the use of prophylaxis for thromboembolic disease (TED) in hospitalized patients with IBD [14,15]. Compared to the general population, patients with IBD are three times as likely to develop TED.…”