A nationwide survey concerning the mortality and risk of progressing severity due to arterial and venous thromboembolism in inflammatory bowel disease in Japan

Koji Ando ,Toshiro Fukui,Sakiko Hiraoka,Masaaki Higashiyama,Masayuki Saruta,Hideo Suzuki,Masahiro Iizuka,Shigeki Bamba,Tsunekazu Mizushima,Hiroki Ikeuchi,Toshiaki Shimizu,Yasuo Suzuki,Kenji Watanabe,Daiki Abukawa,Satoshi Motoya,Katsuyuki Fukuda,Shingo Kato,Hiroshi Nakase,Shinji Tanaka,Takehiro Torisu,Takashi Kagaya,Motohiro Esaki,Makoto Naganuma,Shunichi Yanai,Mikihiro Fujiya,Hideki Iijima,Hisashi Shiga,Taku Kobayashi,Mamoru Watanabe,Kazuhiko Uchiyama,Kiyonori Kobayashi,Masakazu Nagahori,Makoto Sasaki,Tadakazu Hisamatsu

doi:10.1007/s00535-021-01829-5

Abstract

BackgroundThe mortality and risk factors of severe disease and death due to arterial and venous thromboembolism (ATE and VTE, respectively) in patients with inflammatory bowel disease (IBD) remain unclear, especially in Asia.AimsThis study aimed to reveal the mortality and risk factors of TE in IBD patients in Japan.MethodsIn the primary surveillance, responses to questionnaires regarding the number of cases of severe TE and TE-associated death in IBD patients in a span of over the past 10 years were obtained from 32 institutions in Japan. In the secondary surveillance, detailed data about IBD patients with TE were collected. The characteristics, laboratory data, therapy status, and situation at the time of TE development were retrospectively collected, and the data were compared between the patients with and without severe TE and TE-associated death.ResultsThe incidence of TE was 1.89% among 31,940 IBD patients. The frequencies of severe TE and TE-associated mortality were 10.7% and 1.0% among the total IBD and TE with IBD patients, respectively. The only risk factor for severe ATE and ATE-associated death was ischemic heart disease. The independent risk factors for severe VTE and VTE-associated death were age (≤ 45 years old), the site of VTE, and disease severity, with anti-TNF therapy as a potential negative risk factor. Patients with severe VTE had a high risk of developing persistent VTE and sequelae.ConclusionUnlike ATE, the incidence of VTE was comparable in Asian and Western countries. Therapeutic and prophylactic strategies for managing IBD-associated TE in Asia are urgently needed.

Highlights

Inflammatory bowel disease (IBD) is a chronic and relapsing intestinal and systemic inflammatory disorder that has two main phonotypes: ulcerative colitis (UC) and Crohn’s disease (CD)
Several reports have suggested that inflammatory bowel disease (IBD) patients have an increased risk of arterial thromboembolism (ATE), including ischemic heart disease (IHD) and cerebrovascular disease (CVD), compared with non-IBD patients [9,10,11]
A questionnaire concerning the incidence of TE, ATE, venous thromboembolism (VTE), and severe TE and TE-associated death in IBD patients was distributed to participating institutions on the Research Committee of Inflammatory Bowel Disease the Ministry of Health and Welfare of Japan, and 32 institutions responded to the questionnaire

Summary

Introduction

Inflammatory bowel disease (IBD) is a chronic and relapsing intestinal and systemic inflammatory disorder that has two main phonotypes: ulcerative colitis (UC) and Crohn’s disease (CD). In that study, the risk factors of in-hospital death in patients with IBD were suggested to be UC, an older age, presence of comorbidities, health insurance (Medicare or Medicaid), and IBD-related surgery in addition to VTE [15]. The mortality and risk factors of severe disease and death due to arterial and venous thromboembolism (ATE and VTE, respectively) in patients with inflammatory bowel disease (IBD) remain unclear, especially in Asia. Detailed situation at onset of TE Medical situation at onset of TE Ambulatory (N,%) Hospitalization (N,%) Hospitalization until onset of TE (days) Clinical activity at onset of TE Partial Mayo (UC) CDAI (CD) Patients with moderate to severe IBD activity (N,%) Antithrombotic drugs before onset of TE (N,%)

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Conclusion