Abstract Background Inflammatory bowel diseases, including Crohn’s disease and ulcerative colitis, have been associated with an increased risk of venous thromboembolism (VTE). However, data on VTE is lacking in large population-based cohorts of microscopic colitis (MC). We aimed to investigate the association between MC and VTE. Methods We included all Swedish adults (≥18 years) with MC without previous VTE (1990-2017, n=12,489, follow-up until 2021). MC and subtypes (collagenous colitis and lymphocytic colitis) were defined from prospectively recorded colorectal histopathology reports from all 28 pathology departments in Sweden. MC patients were matched for age, sex, calendar year and county of residence with up to five reference individuals (n=55,809) without MC or previous VTE from the general population. Sensitivity analyses included full sibling comparisons and stricter definition of VTE requiring a primary diagnosis of VTE. Incidence rates and multivariable-adjusted hazard ratios (aHRs) with 95% confidence interval (CI) were calculated using Cox proportional hazards modelling. Results Over a median of 10.0 years of follow-up, 755 (6.0%; 11.3/1000 person-years [95%CI 10.5-12.1]) VTE events occurred in individuals with MC and 2674 (4.8%; 8.6/1000 person-years [8.3-8.9]) in reference individuals. Individuals with MC had a higher overall relative risk of any VTE event compared with reference individuals (aHR 1.21 [1.11-1.32]), including higher risk of pulmonary embolism (aHR 1.23 [1.08-1.40]), deep vein thrombosis of the legs (aHR 1.16 [1.03-1.32), and other VTE events (aHR 1.31 [1.08-1.58]). Compared to full siblings, individuals with MC showed numerically, but statistically non-significant, higher relative risk of VTE (aHR 1.15 [0.98-1.35]). Restricting the outcome definition to VTE diagnoses recorded as the primary diagnosis, the estimate of any VTE event was similar for MC overall (aHR 1.26 [1.15-1.39]). In the stratified analyses of VTE there were no major differences in sex, age group, follow-up time, year of MC diagnosis, country of birth, and presence/absence of celiac disease diagnosis at the index date. Conclusion In this population-based study, individuals with MC had a 21% higher risk of VTE compared with reference individuals from the general population, equal to one extra VTE event for every 37 MC individuals followed for ten years.
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