The risk of venous thromboembolism during and after hospitalisation in patients with inflammatory bowel disease activity

Abstract

Summary Background Inflammatory bowel disease (IBD) increases the risk of venous thromboembolism. Aims To determine when patients are at high risk of thromboembolic events, including after major surgery, and to guide timing of thromboprophylaxis. Methods Each IBD patient from Clinical Practice Research Datalink, linked with Hospital Episode Statistics, was matched to up to five non‐IBD patients in this cohort study. We examined their risk of thromboembolism in hospital and within 6 weeks after leaving hospital, with or without undergoing major surgery, and while ambulant. Hazard ratios were estimated using Cox regression, with adjustment for age, sex, body mass index, smoking and history of malignancy or thromboembolism. Results Overall 23 046 IBD patients had a thromboembolic risk 1.74‐times (95% CI = 1.55‐1.96) higher than 106 795 non‐IBD patients. Among ambulant patients, the thromboembolic risk was raised during acute (hazard ratio = 3.94, 2.79‐5.57) or chronic disease activity (3.97, 2.90‐5.45) but their absolute risk remained below 5/1000 person‐years. The hazard ratio for thromboembolism among in‐patients not undergoing major surgery was 1.13 (0.63‐2.02), compared to 2.43 (1.20‐4.92) among surgical patients, with a near doubling of absolute risk associated with surgery (59.5/1000 person‐years, compared with 31.1 without surgery). The absolute risk remained elevated within 6 weeks after leaving hospital (18.6/1000 person‐years in IBD patients after surgery). Conclusions IBD patients are at an increased risk of venous thromboembolism. Absolute risks are raised during active disease, when in hospital, and after leaving hospital following major surgery.

Letter: different risks of venous thromboembolism in subsets of patients with inflammatory bowel diseases

“…We are delighted by the interest shown in our paper by Ding et al 1,2 We would agree with Ding et al that having identified patients from records of healthcare in the UK for our analysis, our results are only generalisable to this population with certainty. We would expect, however, that they could be generalised to populations with similar features and living in areas with comparable healthcare systems.…”

“…For instance, data from a recent study showed that although East Asian IBD patients carried 2-fold increased risk of VTE, the incidence of VTE in that population was lower than that in Western countries, which might imply a different strategy. 2 Secondly, the incidence of VTE in UC patients was significantly higher than those with Crohn's disease 3 but the percentage of UC in the enrolled IBD patients was not provided. And lastly Chu et al pointed out the potential increased risk sustained even after the patients had left hospital, but did not look into the underlying mechanism.…”

A clinical predictive model for post‐hospitalisation venous thromboembolism in patients with inflammatory bowel disease

“…This study and others have led to consensus guidelines recommending thromboprophylaxis during hospitalisation but not in the ambulatory setting . In a recent administrative database study from the UK, the risk of VTE within 6 weeks post‐discharge was 19.7 and 12.3 per 1000 person years for post‐surgical and medical IBD patients respectively, suggesting that the post‐discharge period may remain a vulnerable period for IBD patients . In previous studies involving high‐risk hospitalised patients with medical illness who did not receive extended thromboprophylaxis, the reported rates of symptomatic VTE ranged from 0.75% to 1.5% within 45 days of discharge .…”

“…Therefore, the post‐discharge setting likely remains a vulnerable period for patients with IBD. A recent study using health administrative date found a substantial risk of VTE following discharge in medical and surgical IBD patients; however, patients were only followed for a total of 6 weeks and potential risk factors for VTE were not assessed . Given the paucity of literature in this area, our aims were to assess the incidence and risk factors for VTE in IBD patients in the post‐discharge setting and to create a simple point of care risk stratification tool to guide prophylaxis decisions in the post‐discharge setting.…”

Editorial: increasing IBD prevalence and its complications in the context of the COVID‐19 pandemic

“…In their paper, King et al, show an adjusted hazard ratio of 1.4 for developing colorectal cancer for those with ulcerative colitis. The risk of other significant and potentially fatal complications of IBD such as other cancers (both related to IBD and its treatment), venous thromboembolism, malabsorption, poor mental health and infection has been addressed elsewhere 3‐6 …”