Clinical Issues-January 2023

Area of Science:

• Pharmacology and Gastroenterology
• Clinical Risk Management

Background:

• Janus kinase (JAK) inhibitors, such as tofacitinib, are used for inflammatory bowel disease (IBD), including ulcerative colitis.
• JAK inhibitor therapy has been associated with an increased risk of venous thromboembolism (VTE).
• Effective VTE risk assessment and prophylaxis are critical in managing patients with IBD, particularly those undergoing surgery.

Purpose of the Study:

• To review the association between Janus kinase (JAK) inhibitor therapy and venous thromboembolism (VTE) risk factors in patients with inflammatory bowel disease (IBD).
• To evaluate the utility of validated venous thromboembolism risk assessment tools, such as the Caprini risk assessment model (RAM).
• To examine the optimal timing and communication strategies for VTE risk assessment and management in the perioperative setting.

Main Methods:

• Literature review and synthesis of evidence regarding JAK inhibitor therapy and VTE risk.
• Analysis of the application and validation of risk assessment models like the Caprini RAM in clinical workflows.
• Examination of protocols for preoperative VTE risk assessment and postoperative risk communication.

Main Results:

• Janus kinase (JAK) inhibitors are linked to increased venous thromboembolism (VTE) risk in patients with inflammatory bowel disease (IBD).
• The Caprini risk assessment model (RAM) is a validated tool for identifying VTE risk, aiding clinical workflow and patient assessment.
• Effective communication of VTE and bleeding risks during patient handovers is essential for safe postoperative care.

Conclusions:

• Extended-duration prophylaxis may be considered for inflammatory bowel disease (IBD) patients on Janus kinase (JAK) inhibitors.
• Integrating validated venous thromboembolism (VTE) risk assessment tools into clinical practice improves risk identification and management.
• Standardized preoperative assessment and clear communication of risks are vital for optimizing patient safety and outcomes.