Venous and arterial thromboembolism in patients with inflammatory bowel diseases

Abstract

The risk of thromboembolism (TE) is increased in patients with inflammatory bowel disease (IBD), mainly due to an increased risk of venous TE (VTE). The risk of arterial TE (ATE) is less pronounced, but an increased risk of cardiovascular diseases needs to be addressed in IBD patients. IBD predisposes to arterial and venous thrombosis through similar prothrombotic mechanisms, including triggering activation of coagulation, in part mediated by impairment of the intestinal barrier and released bacterial components. VTE in IBD has clinical specificities, i.e. , an earlier first episode in life, high rates during both active and remission stages, higher recurrence rates, and poor prognosis. The increased likelihood of VTE in IBD patients may be related to surgery, the use of medications such as corticosteroids or tofacitinib, whereas infliximab is antithrombotic. Long-term complications of VTE can include post-thrombotic syndrome and high recurrence rate during post-hospital discharge. A global clot lysis assay may be useful in identifying patients with IBD who are at risk for TE. Many VTEs occur in IBD outpatients; therefore, outpatient prophylaxis in high-risk patients is recommended. It is crucial to continue focusing on prevention and adequate treatment of VTE in patients with IBD.

Risiko venöser Thromboembolien bei Autoimmunerkrankungen: Eine umfassende Übersicht

“…Obwohl TVT der unteren Extremitäten und PE die häufigsten klinischen Präsentationen sind, wurden auch ungewöhnliche Lokalisationen für Thrombosen beschrieben [87]. CED wurden auch als Risikofaktoren für das Wiederauftreten von Thrombosen bei Patienten mit einer früheren unprovozierten VTE identifiziert [88]. Novacek et al [89] verglichen erstmals das Risiko einer rezidivierenden VTE bei Patienten mit CED und Patienten ohne CED mit einer ersten unprovozierten VTE: Die Wahrscheinlichkeit eines Rezidivs nach 5 Jahren betrug 33,4% bei Patienten mit CED und 21% bei Patienten ohne CED.…”

Venous Thromboembolism in Patients with Inflammatory Bowel Disease

“…In recent times, significant shifts have occurred in anticoagulation treatment choices, primarily attributed to the advent of direct oral anticoagulants (DOACs) [ 70 ]. These medications, which include direct factor Xa inhibitors (such as rivaroxaban, apixaban, and edoxaban) and a thrombin inhibitor (dabigatran), bring several advantages to the table, such as obviating the need for INR monitoring or heparin bridging.…”

“…DOACs might have a particularly valuable role in managing outpatients with IBD. Controlled trials are necessary to confirm their potential benefits over warfarin in IBD patients experiencing VTE [ 70 ].…”

Atherosclerotic Cardiovascular Disease in Inflammatory Bowel Disease: The Role of Chronic Inflammation and Platelet Aggregation

“…Aggregation (Ag) and activation of platelets play a crucial role in myocardial infarction, unstable angina pectoris, and stroke [ 33 ]. Moreover, elevated proinflammatory cytokines in patients with IBD, such as TNF-α and IL-1, can induce changes in endothelial cells, monocytes, macrophages, and platelets, such as upregulation of tissue factor, which binds plasma factor VIIa, resulting in procoagulant activity [ 34 , 35 , 36 ]. In addition, in patients with IBD, decreased levels of protein C and protein S, increased plasma levels of PAI-1, and reduced plasma levels of thrombin-activatable fibrinolysis inhibitor (TAFI) were found, indicating the imbalance of fibrinolysis in IBD [ 35 , 37 ].…”