Risk of thromboembolic phenomena in patients with inflammatory bowel disease

• Published in: Gastroenterología y hepatología Vol. 35; no. 9; p. 634
• Main Authors: Suárez Ferrer, Cristina, Vera Mendoza, María Isabel, Amo San Román, Leticia, González Lama, Yago, Calvo Moya, Marta, García Casas, Mercedes, Abreu García, Luis
• Format: Journal Article
• Language: Spanish
• Published: Spain 01-11-2012
• Subjects: Anticoagulants - therapeutic use; Colitis, Ulcerative - complications; Colitis, Ulcerative - genetics; Colonic Diseases - complications; Constriction, Pathologic; Contraceptives, Oral, Hormonal - adverse effects; Crohn Disease - complications; Crohn Disease - genetics; Family Health; Female; Heparin - therapeutic use; Hospital Units; Hospitalization; Humans; Ileal Diseases - complications; Intestinal Fistula - etiology; Male; Middle Aged; Pregnancy; Pregnancy Complications, Hematologic; Pulmonary Embolism - epidemiology; Pulmonary Embolism - etiology; Retrospective Studies; Risk; Smoking - adverse effects; Smoking - epidemiology; Spain - epidemiology; Tertiary Care Centers - statistics & numerical data; Thromboembolism - epidemiology; Thromboembolism - etiology; Thromboembolism - prevention & control; Thrombophilia - etiology; Thrombophilia - genetics; Venous Thrombosis - epidemiology; Venous Thrombosis - etiology; Spain
• ISSN: 0210-5705
• DOI: 10.1016/j.gastrohep.2012.07.003

Inflammatory bowel disease (IBD) is an independent risk factor for thromboembolic phenomena (TEP). We evaluated the prevalence and the possible risk factors associated with developing TEP in patients with IBD in our center.
Data were retrospectively collected from January 1995 to December 2011 from 23 patients. A total of 61% were diagnosed with Crohn's disease (CD) and 39% with ulcerative colitis (UC) according to routine criteria.
When the Montreal classification was used, 58% of the patients with CD had an inflammatory pattern (B1), 25% a stenosing pattern (B2) and 17% a fistulizing pattern (B3). Half the patients had ileocolic involvement (L3), one-third had colonic involvement (L2) and the remainder had ileal involvement (L1). Among patients with UC according to the Montreal classification, 78% had extensive colitis (E3), 11% had left colonic involvement (E2) and 11% had proctocolitis (E1). During the event, almost half the patients with UC had severe inflammatory activity (S3; 44%), 33% had mild-moderate activity (S1: 22%, S2: 11%) and only 22% were in remission (S0). Overall, at the time of the TEP, 48% of the patients had mild-moderate activity and 22% had severe activity. Likewise, 44% were hospitalized at the time of the event. In UC, an increase in the prevalence of TEP was found in admitted patients (66%). None of the patients had a family history of TEP, two patients (9%) had associated thrombophilia and 26% were active smokers. There were no TEP during pregnancy. Only one patient was taking contraceptive pills when the event occurred. The most frequent forms of TEP were deep vein thrombosis of the legs (55%) followed by pulmonary thromboembolism (25%).
TEP are relatively frequent in patients with IBD, with a strong impact on morbidity and mortality. In our series, risk factors for these events were more extensive involvement (any of the groups) and severe inflammatory activity. No significant association between classical risk factors such as the use of contraceptives, pregnancy, coagulation disorders or smoking and the risk of TEP were found.