Thrombosis in the setting of obesity or inflammatory bowel disease

Abstract

Obesity and inflammatory bowel disease (IBD) are systemic inflammatory disorders that predispose to arterial and venous thrombosis through similar prothrombotic mechanisms. Obesity and IBD are chronic risk factors that lead to a persistently elevated risk of thrombosis, although the thrombotic risk with IBD appears to wax and wane with disease severity. Because of the lack of high-quality evidence to guide management decisions, approaches to the prevention and treatment of thrombosis in patients with obesity or IBD are based on extrapolation from general guidelines for antithrombotic therapy. Obesity alters the pharmacokinetics of some anticoagulant drugs, and IBD patients present the added management challenge of having a high risk of gastrointestinal bleeding while taking anticoagulants. An extended duration of anticoagulant therapy is often recommended for obese or IBD patients with unprovoked venous thromboembolism unless there is a high risk of bleeding, although more data and better biomarkers are needed to determine whether anticoagulation can be safely stopped in a subset of IBD patients during remission of active disease. Most patients with obesity or IBD require thromboprophylaxis in conjunction with hospitalization or surgery, with adjustment of anticoagulant dosing in patients with severe obesity.

Involvement of inflammatory markers in pathogenesis of venous thromboembolism

“…An important argument in favor of the impact of inflammation in venous thromboembolism is the elevated risk of venous thrombosis and embolism in different inflammatory diseases, such as vasculitis, sarcoidosis, rheumatoid arthritis, inflammatory myopathies, gout, celiac and inflammatory bowel disease and perhaps other autoimmune diseases [5][6][7][8][9][10][11][12].…”

“…Moreover, the metabolic syndrome -abdominal obesity, insulin resistance, arterial hypertension, hypertriglyceridemia, low HDL (high density lipoprotein) cholesterol -an important risk factor of the atherosclerotic disease, has been recently associated with venous thromboembolism [4][5][6][7][8][9][10][11][12][13][14][15].…”

Current knowledge in pathophysiology and management of Budd-Chiari syndrome and non-cirrhotic non-tumoral splanchnic vein thrombosis

“…In general, obesity is a risk factor for the first episode of venous thromboembolism (VTE) with an estimated overall odds ratio for VTE of 2.3. 54 Obesity is also a risk factor for recurrent VTE with an estimated hazard ratio of 1.6, a degree of risk similar to that of other risk factors for recurrent VTE. 54 In addition to clinical factors such as immobility, obstructive sleep apnoea, heart failure, and venous stasis, the major mechanisms proposed to be responsible for obesity-associated thrombosis are impaired fibrinolysis, and chronic inflammation.…”

In silico thrombin generation: Plasma composition imbalance and mortality in human immunodeficiency virus

“…Risk predictions for thrombotic‐related outcomes are mostly based upon genetic factors (AT,62 PC,63 and protein S64 deficiencies; FV Leiden65 and prothrombin G20210A66 mutations), increases in coagulation factors (notably FVIII,67 FIX,68 FXI69) and environmental factors (obesity,70 oral contraceptive use,71 hormone replacement therapy,71 age,72 alcohol use,73 and potentially smoking74). The heterologous presence of any of these circumstances in any individual may still be asymptomatic and does not ordinarily necessitate clinical intervention.…”