High incidence of postoperative silent venous thromboembolism in ulcerative colitis: a retrospective observational study

Norimitsu Shimada,Hiroki Kitagawa,Yusuke Watadani,Norifumi Shigemoto,Kosuke Yoshimura,Shinya Takahashi,Hiroki Ohge,Shinnosuke Uegami,Kenichiro Uemura

doi:10.1186/s12893-021-01250-y

Abstract

BackgroundThe incidence of postoperative venous thromboembolism (VTE) is high in patients with inflammatory bowel disease. We aimed to analyze the incidence and predictive factors of postoperative VTE in patients with ulcerative colitis.MethodsPatients with ulcerative colitis who underwent colon and rectum surgery during 2010–2018 were included. We retrospectively investigated the incidence of postoperative VTE.Results A total of 140 colorectal surgery cases were included. Postoperative VTE was detected in 24 (17.1 %). Portal–mesenteric venous thrombosis was the most frequent VTE (18 cases; 75 %); of these, 15 patients underwent total proctocolectomy (TPC) with ileal pouch–anal anastomosis (IPAA). In univariate analysis, VTE occurred more frequently in patients with neoplasia than in those refractory to medications (27.2 % vs. 12.5 %; p < 0.031). TPC with IPAA was more often associated with VTE development (28 %) than total colectomy (10.5 %) or proctectomy (5.9 %). On logistic regression analysis, TPC with IPAA, total colectomy, long operation time (> 4 h), and high serum D-dimer level (> 5.3 µg/mL) on the day following surgery were identified as predictive risk factors.ConclusionsPostoperative VTE occurred frequently and asymptomatically, especially after TPC with IPAA. Serum D-dimer level on the day after surgery may be a useful predictor of VTE.

Highlights

The incidence of postoperative venous thromboembolism (VTE) is high in patients with inflammatory bowel disease
Restorative proctocolectomy and proctectomy were conducted with rectal mucosectomy and hand-sewn ileal pouch–anal anastomosis (IPAA) with a J pouch
When VTE was detected after total colectomy (TC), proctectomy was conducted after the thrombus had disappeared

Summary

Introduction

The incidence of postoperative venous thromboembolism (VTE) is high in patients with inflammatory bowel disease. We aimed to analyze the incidence and predictive factors of postoperative VTE in patients with ulcerative colitis. Venous thromboembolism (VTE) is a well-known complication after colorectal surgery that leads to morbidity and mortality in hospitalized as well as discharged patients. Patients with ulcerative colitis (UC) show a high incidence of VTE postoperatively. Many previous studies conducted in Western countries found that the risk of postoperative VTE in patients with. Current guidelines from the American Society of Colon and Rectal Surgeons recommend pharmacological prophylaxis with low-dose unfractionated heparin or low-molecular-weight heparin in patients with moderate and high risk for VTE following abdominal surgery. Patients with inflammatory bowel disease (IBD) are defined as having a high risk for VTE [3].

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