The Incidence and Risk Factors of Venous Thromboembolism in Japanese Inpatients With Inflammatory Bowel Disease: A Retrospective and Prospective Study

Abstract

BACKGROUND: Venous thromboembolism (VTE) has been reported as a major extra-intestinal manifestation in inflammatory bowel disease (IBD) in Western countries. However, the incidence and risk factors of VTE in Asian IBD patients are not fully understood. The aim of this study is to reveal the incidence and risk factors of VTE in Japanese IBD inpatients. METHODS: Retrospective study; The incidence of VTE in inpatients with IBD (n=340), gastrointestinal cancers (n=557) and other gastrointestinal diseases (n=569) treated at our hospital from 2009 to 2013 was retrospectively investigated. The characteristics and laboratory data of IBD patients with and without VTE were compared. Prospective multicenter study; The incidence of VTE in inpatients with IBD (n=41) was compared with that in inpatients with other digestive diseases (n=30) at 3 gastroenterology centers. The presence of VTE was investigated using enhanced computed tomography and/or ultrasonography at two points (on admission, and one to two weeks later). RESULTS: Retrospective study; VTE was detected in 7.1% of IBD patients. This rate was significantly higher than in gastrointestinal cancer patients (2.5%) and patients with other gastrointestinal diseases (0.88%). The incidence of VTE in ulcerative colitis (UC) patients (16.9%) was significantly higher than that in Crohn's disease (CD) patients (3.6%). VTE occurred at catheter indwelling sites and in the cerebral venous sinus and portal vein as well as in the lower limbs. According to a univariate analysis, an older age, central venous catheter, prednisolone, surgery, low serum albumin, high serum C-reactive protein and D-dimer were identified as risk factors. According to a multivariate analysis, >50 years of age and surgery were the only risk factors. The mortality rate associated with VTE was 4.2%. No hemorrhagic complications related to anticoagulant therapy occurred. Prospective multicenter study; The incidence of VTE was markedly higher in IBD patients (17.1%) than in patients with other digestive diseases (3.3%). The incidence of VTE in patients with UC (28.6%) was much higher than in those with CD (5.0%). The seven IBD inpatients with VTE consisted of four patients with VTE detected on admission and three patients with VTE detected after admission. CONCLUSION(S): VTE was frequently detected in IBD patients, especially those with UC, both on and after admission. The efficacy of prophylaxis against VTE based on risk classification should be investigated in Asian IBD patients.