Local thrombolysis: a newer approach to treating inflammatory bowel disease-related thromboembolism

To review the experience with a relatively novel treatment, local thrombolysis, in patients with inflammatory bowel disease (IBD)-related thromboembolism (TE).

TE is an extraintestinal complication of IBD for which there are no clear treatment guidelines. Systemic treatment with anticoagulants or thrombolytics often raises fear of hemorrhagic complications, particularly hematochezia.

Cases of IBD-related and non-IBD-related TE treated with local thrombolysis were searched for in PubMed, reviewed, and grouped into anatomic areas. Outcomes in each anatomic area were compared between IBD and non-IBD patients. Due to the small number of IBD-related TE cases, a descriptive, not statistical, analysis was performed.

There were 17 cases of IBD-related TE treated with local thrombolysis grouped as follows: 7 of cerebral venous thrombosis, 3 of lower extremity arterial TE, 1 of deep vein thrombosis, 1 of upper extremity deep vein thrombosis, 3 of abdominal vein thrombosis, and 2 of inferior vena cava TE. Mean age was 32 (range, 14 to 50) years, and 13 of 17 patients were female. Twelve had ulcerative colitis, 3 had Crohn's disease, and 1 was indeterminate. Four of the 7 patients with active IBD had pretreatment hematochezia, 2 of whom had worsening of hematochezia secondary to treatment. The rates of radiologic resolution, clinical resolution, and hemorrhagic complications in the IBD patients were favorable in all the anatomic areas and were very similar to non-IBD patients.

Local thrombolysis may be considered a viable therapeutic option for IBD-related TE. As more cases of local thrombolysis for IBD-related TE accumulate, further recommendations can be made as to the indications for its use.