Safety of Venous Thromboembolism Pharmacological Prophylaxis in Hospitalized Patients With Inflammatory Bowel Disease...

Hospitalization secondary to inflammatory bowel disease (IBD) exacerbation is a significant risk factor for venous thromboembolism (VTE). Guidelines recommend the use of thromboprophylaxis; however, the risk of bleeding is unknown. We therefore aimed to evaluate the safety of pharmacological thromboprophylaxis in hospitalized patients with IBD.

This was a retrospective cohort study. IBD patients' electronic health records were reviewed between 2017 and 2024. Patients with severe IBD exacerbation were included. The primary outcome was the safety of VTE prophylaxis, investigated by increased bleeding risks during admission. This included worsening bloody stool frequency, a drop in hemoglobin (>1 g/dL from baseline) and development of hemorrhagic shock. Worsening bloody stool frequency was defined as increased bloody stool frequency >1 from baseline before starting VTE prophylaxis.

A total of 1045 patient encounters were reviewed; after applying our inclusion/exclusion criteria, 353 patients were included in our study. Most patients were hospitalized with acute severe ulcerative colitis (ASUC), 213 (60.3%), and 140 (39.7%) had Crohn's disease (CD) exacerbation. Of the total cohort, 264 (75%) patients received enoxaparin 40 mg for VTE prophylaxis, and 89 (25%) patients received 5000 units of unfractionated heparin twice a day. Eighteen (%5) patients had a history of VTE. None of the study participants had any bleeding events, including worsening bloody stool frequency, major bleeding and development of hemorrhagic shock after starting VTE prophylaxis.

Our findings suggest that there is no increased risk of bleeding in patients admitted with IBD exacerbation receiving pharmacological VTE prophylaxis during the admission period. However, prospective data, including high-risk patients (e.g., patients with cancer and pregnant women), is warranted.