Thrombosis risk doubled in IBD patients
MedWire News: Patients with inflammatory bowel disease (IBD) are twice as likely as people who have not been diagnosed with to develop venous thromboembolism (VTE), study findings indicate.
"The relative risks were particularly high at young ages, though the absolute risks increased with age," remark Michael Kappelman (University of North Carolina, Chapel Hill, USA) and colleagues in the journal Gut.
The researchers used data from the Danish National Patient Registry to determine the risk for VTE (deep vein thrombosis [DVT] and pulmonary embolism [PE]) in children and adults with IBD, and evaluate whether this risk varies by age and/or the presence of other risk factors.
The study included 49,799 patients with IBD (14,211 Crohn's disease, 35,229 ulcerative colitis, 359 unspecified IBD) and 477,504 members of the general population who had not been diagnosed with IBD.
Overall, patients with IBD had a two-fold higher risk for all VTE than the general population and a 1.6-fold increased risk for unprovoked VTE. Risks were slightly higher among patients with Crohn's disease (hazard ratio [HR]=2.2), compared with those with ulcerative colitis (HR=1.9).
The researchers note that VTE incidence increased with age, from 8.9 cases per 10,000 patients aged 20 years and younger, to 54.6 cases per 10,000 patients aged more than 60 years.
In spite of this, the relative risk for VTE was substantially higher among younger patients. Specifically, those aged 20 years and younger had a six-fold higher risk for DVT than the general population and a 6.4-fold higher risk for PE. By comparison, DVT risk was a respective 1.6- and 1.7-fold higher among patients aged 60 years and older, relative to the general population.
After adjusting for additional thromboembolic risk factors, including diabetes, heart failure, myocardial infarction, stroke, and hormone replacement therapy or antipsychotic medication use, patients with IBD still had a 50% higher risk for VTE than controls.
This strongly suggests "that IBD is an independent prothrombotic risk factor," say Kappelman and co-authors.
They comment that their findings indicate that there is a need to modify the currently recommended "one size fits all" approach to recommendations regarding VTE prophylaxis in IBD patients.
"We suggest that guidelines and individual patient decisions about VTE prophylaxis in patients with IBD should take into account patient-specific estimates of absolute risk as well as both the safety and efficacy of different prophylaxis regimens," the authors write.
"We also urge physicians to be vigilant and have a low threshold to carefully evaluate patients with IBD who develop the signs or symptoms of possible VTE."
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By Laura Dean