From Inflammation to Thrombosis: The Prothrombotic State and Cardiovascular Risk in Inflammatory Bowel Disease

Area of Science:

• Cardiovascular Medicine
• Gastroenterology
• Immunology

Background:

• Inflammatory bowel disease (IBD) is linked to higher risks of venous thromboembolic events (VTEs) and arterial cardiovascular events.
• A thromboinflammatory state, driven by gut inflammation, impacts vascular homeostasis via immune activation and coagulation pathways.

Purpose of the Study:

• To review the association between IBD and cardiovascular events.
• To discuss the pathophysiological mechanisms linking gut inflammation to thrombosis.
• To outline clinical strategies for prevention and management.

Main Methods:

• Review of pathophysiological data and clinical evidence.
• Analysis of the interplay between intestinal inflammation, immune response, and vascular events.
• Synthesis of current guidelines for VTE prophylaxis and cardiovascular prevention in IBD patients.

Main Results:

• IBD patients face increased VTE and moderate arterial cardiovascular event risks, influenced by disease activity and acute care.
• The thromboinflammatory phenotype involves innate immunity, coagulation-platelet interactions, endothelial dysfunction, and impaired fibrinolysis.
• Recurrence of VTE depends on anticoagulation and minimizing inflammatory/treatment exposures.

Conclusions:

• Integrated care focusing on sustained, steroid-sparing IBD control and guideline-based thromboprophylaxis is crucial.
• Cardiovascular risk assessment and optimization of modifiable factors are recommended before escalating IBD therapy.
• Future strategies may involve personalized risk assessment and targeted therapies for the gut-vascular interface and immunothrombosis.