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Venous thromboembolism in inflammatory bowel disease
Craig A Solem1, Edward V Loftus, William J Tremaine
1Division of Gastroenterology and Hepatology, Mayo Clinic and Foundation, Rochester, Minnesota 55905, USA.
The American Journal of Gastroenterology
|December 23, 2003
Summary
Venous thromboembolism (VTE) is a serious complication of inflammatory bowel disease (IBD). While thrombophilia is common, other risk factors are usually present, and proctocolectomy does not prevent recurrence.
Area of Science:
- Gastroenterology
- Hematology
- Vascular Medicine
Background:
- Inflammatory bowel disease (IBD) is associated with an increased risk of venous thromboembolism (VTE).
- Understanding the clinical characteristics, risk factors, and outcomes of VTE in IBD patients is crucial for management.
Purpose of the Study:
- To describe the clinical features of VTE in patients with IBD.
- To identify acquired and congenital risk factors for VTE in IBD.
- To evaluate the outcomes of VTE in IBD patients, including recurrence and mortality.
Main Methods:
- Retrospective review of patients with IBD and VTE (deep venous thrombosis or pulmonary embolism) from 1991-2000.
- Data abstraction included clinical features, risk factors, treatment, and outcomes.
- Analysis of VTE recurrence rates in patients who underwent proctocolectomy versus those with intact colons.
Main Results:
- The study identified 59 ulcerative colitis (UC) and 39 Crohn's disease (CD) patients with VTE.
- Active disease was present in 80% of CD and 79% of UC patients.
- Thrombophilia was found in 33% of tested patients, but most (87%) had other VTE risk factors.
- Recurrent VTE occurred in 13% of CD patients and 13% of UC patients post-proctocolectomy.
- The overall mortality rate was 22% after a median follow-up of 1.8 years.
Conclusions:
- VTE is a significant and potentially fatal complication of IBD.
- Thrombophilia testing has a high diagnostic yield, though specific genetic factors are uncommon.
- Multiple risk factors often contribute to VTE in IBD.
- Proctocolectomy does not confer protection against recurrent VTE.