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Celiac Disease and Thrombotic Events: Systematic Review of Published Cases
Nikola Pantic1, Ivana Pantic2, Dorde Jevtic3,4
1Clinic of Hematology, University Clinical Center of Serbia, 11000 Belgrade, Serbia.
Insights
Celiac disease (CD) can manifest with thrombotic events, even without typical intestinal symptoms. This systematic review highlights the occurrence and management of thrombosis in CD patients.
Area of Science:
- Gastroenterology
- Hematology
- Internal Medicine
Background:
- Celiac disease (CD) is an autoimmune disorder with diverse extraintestinal manifestations.
- Thrombotic events are an under-recognized complication of CD, occurring even in individuals without classic gastrointestinal symptoms.
Purpose of the Study:
- To systematically review and synthesize data on thrombotic events associated with celiac disease.
- To investigate the timing of CD diagnosis relative to thrombotic events and common thrombosis sites.
Main Methods:
- A systematic literature review was performed using the PubMed/MEDLINE database up to January 2022.
- Data from 55 case reports and case series on celiac disease and thrombosis were analyzed.
- PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed.
Main Results:
- Hepatic vein thrombosis was the most frequent site (30.91%), followed by cerebral, lower extremity DVT, and pulmonary thromboembolism.
- In most cases (65.46%), thrombosis occurred before or concurrently with the CD diagnosis.
- Thrombosis was typically isolated to a single site (78.18%).
Conclusions:
- Thrombotic events, particularly hepatic vein thrombosis, are significant extraintestinal manifestations of celiac disease.
- Consideration of celiac disease in patients presenting with thrombosis is crucial, as diagnosis may precede or coincide with thrombotic events.
- Management often involves anticoagulation and a gluten-free diet.
Abstract:
Extraintestinal manifestations of celiac disease (CD) should be considered, even in patients without typical intestinal symptoms. The aim of our study is to examine the literature regarding the occurrence of thrombotic events in CD, and to synthesize the data from case reports and case series. A systematic review of the literature was conducted by searching the Pub-Med/MEDLINE database, from the date of database inception to January 2022, to identify published cases and case series on this topic, in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A total of 55 cases were included in the study. The majority of patients were previously healthy individuals, with no comorbidities. In less than one-third of the cases (30.91%), the diagnosis of CD was established before the onset of thrombosis, while in the remaining cases (34.54%), thrombosis preceded the diagnosis or was diagnosed concomitantly with CD. The most common sites for thrombosis occurrence were hepatic veins (30.91%), while thrombosis of cerebral blood vessels, deep venous thrombosis of lower extremities, and pulmonary thromboembolism were less frequent. Thrombosis was most commonly isolated to one site only (78.18%). In 69.09% of cases (n = 38), some form of anticoagulation, along with a gluten-free diet, was initiated.
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