Venous Thromboembolism Risk in Asian Patients with Inflammatory Bowel Disease: A Population-Based Nationwide Inception Cohort Study

Abstract

Background/Aims Inflammatory bowel disease (IBD) is associated with the occurrence of venous thromboembolism (VTE). However, to date, there have been few studies on the risk of VTE in Asian IBD patients. We aimed to estimate the incidence of VTE in Asian IBD patients and to determine if IBD is related to increased VTE risk. Methods We performed a population-based cohort study between 2004 and 2015 using Korean National Health Insurance data. IBD and VTE were defined by ICD-10 codes. Incidence rates of VTE were calculated among patients with IBD and among age- and sex-matched controls. Hazard ratios were estimated using Cox regression with adjustment for multiple variables. We performed additional analyses stratifying by age, sex, Charlson comorbidity index (CCI) score, and disease type. Results Among the 45,037 patients with IBD (IBD cohort) and 133,019 matched controls (non-IBD cohort) included in our analysis, 411 IBD patients and 641 controls developed VTE. The IBD cohort had a higher incidence rate ratio and risk of VTE than the non-IBD cohort (incidence rate ratio 1.92 and hazard ratio 1.93). Older age, female sex, higher CCI scores, cardiovascular disease, chronic kidney disease, use of steroids, and hospitalization were significant risk factors for VTE in patients with IBD. Conclusions The IBD patients in this study were approximately two times more likely to develop VTE than the non-IBD individuals. Our findings support the need for thromboprophylaxis in Asian IBD patients with various factors that further increase the risk of VTE.

Immune-mediated inflammatory diseases and risk of venous thromboembolism: A Mendelian randomization study

“…The IBD GWAS dataset used in this study combines UC and CD, whereby we performed separate MR analyses on total IBD, UC, and CD. Unlike previous studies which reported that the risk of VTE was increased in both CD and UC patients (35)(36)(37), the MR evidence provided by this study only showed a causal relationship between UC and VTE. Notably, the meta-analysis results published by Fumery, M et al showed a significantly higher risk of VTE in UC inpatients than in CD inpatients (P = 0.0029) (14), which together with our findings suggested that UC patients may have a greater risk of VTE compared with CD patients.…”

“…Previous observational studies reported an increased risk of thrombosis in IBD patients ( 34 ), in accordance with our findings based on MR analysis. Furthermore, two recent cohort studies based on Asian populations reported that IBD patients are 1.80-, 1.98- and 2-fold more likely to develop PE, DVT ( 35 ), and VTE ( 36 ), respectively. A meta-analysis summarizing data from 11 observational studies covering 3,175,012 IBD patients and 920,144,253 controls showed an RR of 2.03 (95% CI: 1.72-2.39) for the occurrence of VTE in the former group ( 37 ).…”

Prevalence, risk factors and implication of venous thromboembolism in inflammatory bowel disease

“…Significant risk variables for VTE in individuals with IBD were older age, female sex, higher Charlson comorbidity index scores, cardiovascular illness, chronic kidney disease, use of steroids, and hospitalization. 19 Magro, Soares and Fernandes described in their study that inflammatory activity, hospitalization, surgery, pregnancy, disease phenotype such as fistulizing disease, colonic involvement, and severe involvement, and pharmacological therapy mainly steroids are some acquired variables that enhance the risk of VTE in IBD. Basic science, clinical, and epidemiological studies have also provided strong evidence that IBD is linked to a number of prothrombotic abnormalities, such as the activation of the coagulation system, downregulation of natural anticoagulant mechanisms, impairment of fibrinolysis, increased platelet count and reactivity, and endothelial dysfunction.…”

Global trends in incidence and prevalence of achalasia, 1925–2021: A systematic review and meta‐analysis

“…Achalasia is a rare motility disorder of the esophagus characterized by impaired relaxation of the lower esophageal sphincter 1 . Not only does this condition impose high economic burdens, but it also poses a significant risk factor for esophageal cancer 1,2 …”