S912 Prevention of Venous Thromboembolism in IBD Patients May Not Be Associated With Prophylaxis Rates

Abstract

Introduction: Patients with inflammatory bowel disease (IBD) harbor a higher risk of deep venous thrombosis and venous thromboembolism (VTE) compared to healthy individuals. Previous studies, including a large meta-analysis, estimate the risk of VTE incidence to be almost 2-3 times baseline. Guidelines, therefore, recommend VTE prophylaxis in most inpatients with IBD. While previous studies have demonstrated less than ideal adherence with these guidelines, we sought to determine the rate of VTE prophylaxis at an academic medical center. Methods: A retrospective chart review of inpatients with Crohn’s disease or ulcerative colitis admitted to a tertiary medical center in Bronx, NY from 1/2015 to 2/2020 was performed. All patients who were admitted with a primary gynecological or psychiatric disorder, COVID infection, or known hypercoagulable disorder were excluded. Orders for pharmacologic and mechanical VTE prophylaxis at any point during the patient’s admission were abstracted. Using ICD10 codes, IBD patients with acute VTE variations were identified. Clinical and demographic variables were analyzed for their association with VTE prophylaxis. Two-sample t-tests and Fisher’s exact tests were used as appropriate. A p-value < 0.05 was considered statistically significant. Results: A total of 1670 patients with IBD were identified among whom 1280 (76.7%) were prescribed either pharmacological or mechanical VTE prophylaxis during their hospital admission. 70 patients were excluded from the analysis of development of VTE because their diagnosis of VTE was prior to their admission date. Older age (p< .0001), higher BMI (p< .0001), female sex (p=.001), having Medicare insurance (p< .0001) were associated with VTE prophylaxis ordering (see Table). There was a VTE incidence of 6.2% (n=98/1600) of the IBD patients in our cohort, with 3/388 patients (0.8%) not being prescribed prophylaxis and 95/1212 (7.8%) being prescribed prophylaxis (p< 0.001). Conclusion: Contrary to other studies, we show that VTE prophylaxis rates may not be associated with a reduction in VTE incidence during hospitalization. While bias by indication may be contributing to this finding with those at greatest risk more likely to receive prophylaxis, other factors may be involved. Further studies are warranted. Table 1. - VTE incidence rates and bivariate association of demographical variables with prophylaxis VTE Prophylaxis p-value Total (n) Yes No Demographics 1670 Age, mean (SD) 61.91 (19.85) 42.73 (24.39) < .0001 BMI, mean (SD) 28.11 (8.74) 25.60 (6.15) < .0001 Sex 0.001 Female 726 (56.7) 185 (47.4) Male 554 (43.3) 205 (52.6) Ethnicity 0.79 Hispanic 502 (39.2) 160 (41.0) Not Hispanic 662 (51.7) 194 (49.7) Unknown 116 (9.1) 36 (9.2) Insurance < .0001 CMO 5 (0.4) 0 (0) 0.60 Commercial 263 (20.6) 111 (28.5) 0.002 Medicaid 360 (28.1) 170 (43.6) < 0.0001 Medicare 615 (48.1) 91 (23.3) < 0.0001 Self-Pay 37 (2.9) 18 (4.6) 0.12 Outcome 1600 Developed VTE 95 (7.8) 3 (0.8) -