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Patients with IBD have increased risk of VTE, particularly during periods of active disease, research indicates

Wednesday, February 24 2010 | Comments

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What's This? Patients with inflammatory bowel disease (IBD) have a greater risk of developing venous thromboembolism (VTE) relative to the general population, according to a recently published study.

In addition, the results indicate that this increase in risk is present in both ambulatory and hospitalized patients and is particularly pronounced during periods of active disease. Given this finding, the study authors suggested that VTE prophylaxis strategies--such as those currently used for hospitalized patients with active IBD--might also be warranted for ambulatory patients.

Using the U.K.'s General Research Practice Database, researchers evaluated the risk of VTE (deep vein thrombosis [DVT] or pulmonary embolism) in 13,756 patients with IBD and 71,672 controls without IBD. The researchers used corticosteroid prescription records and IBD-related hospitalizations to categorize periods of disease activity in the patients with IBD as acute (ie, flares), chronic, or remitted.

During a mean follow-up of 3.9 years, 139 patients with IBD and 165 controls developed VTE.

The absolute risk of VTE was 2.6 per 1,000 person-years among the patients with IBD and 0.6 per 1,000 person-years among the controls. In an analysis adjusted for age, sex, body mass index, smoking, and history of cancer, DVT, or pulmonary embolism, the patients with IBD were more than 3 times as likely to develop VTE as compared with the controls (adjusted hazard ratio [HR], 3.4 [95% CI, 2.7-4.3]; P<.0001).

This risk was particularly pronounced during periods of acute disease activity (adjusted HR, 8.4 [95% CI, 5.5-12.8]; P<.0001).

The investigators also evaluated the risk of VTE associated with IBD during hospitalization periods and during ambulatory periods.

The relative risk of VTE at the time of a flare was more pronounced during ambulatory periods (adjusted HR vs controls, 15.8 [95% CI, 9.8-25.5]; P<.0001) than during hospitalized periods (adjusted HR vs controls, 3.2 [95% CI, 1.7-6.3]; P=.0006), although the absolute risk of VTE was greater during hospitalized periods (37.5 cases per 1,000 patient-years) than during ambulatory periods (6.4 cases per 1,000 person-years).

The authors suggested that, when these and other data are considered, "comparison of the risk in patients with IBD with that in well-recognized high-risk groups shows that the absolute risk of VTE in ambulant flares is greater than that in pregnancy and the post-partum period and is at least a similar size to that in patients with cancer (not withstanding the much younger age of patients with IBD)." (Grainge MJ, et al. Lancet 2010;375:657-663.)

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