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VOLUME 13 , ISSUE 2 ( July-December, 2023 ) > List of Articles

REVIEW ARTICLE

Standard and Extended Thromboprophylaxis in Patients with Inflammatory Bowel Disease: A Literature Review

Sidharth Harindranath, Jijo Varghese, Shivaraj Afzalpurkar, Suprabhat Giri

Keywords : Crohn's disease, Inflammatory bowel disease, Ulcerative colitis, Venous thromboembolism

Citation Information : Harindranath S, Varghese J, Afzalpurkar S, Giri S. Standard and Extended Thromboprophylaxis in Patients with Inflammatory Bowel Disease: A Literature Review. Euroasian J Hepatogastroenterol 2023; 13 (2):133-141.

DOI: 10.5005/jp-journals-10018-1401

License: CC BY-NC 4.0

Published Online: 26-12-2023

Copyright Statement:  Copyright © 2023; The Author(s).


Abstract

Patients with inflammatory bowel disease (IBD), both Crohn's disease and ulcerative colitis, frequently experience venous thromboembolism (VTE), a potentially fatal consequence. The pathophysiological mechanisms contributing to VTE include inflammation, modifications in coagulation factors, endothelial dysfunction, and platelet activation. Numerous pro-inflammatory cytokines and markers, such as tumor necrosis factor-alpha and interleukin-6, have a significant impact on the thrombotic cascade. Patients with IBD are more likely to suffer VTE for a variety of causes. Exacerbations of preexisting conditions, admission to the hospital, surgical intervention, immobilization, corticosteroid usage, central venous catheterization, and hereditary susceptibility all fit into this category. The mainstay of therapy for VTE in IBD patients includes anticoagulation that is individualized for each patient depending on the thrombosis site, severity, bleeding risk, and interaction with other drugs. In some high-risk IBD patients, such as those having major surgery or hospitalized with severe flare, preventive anticoagulation may play a role. However, the acceptance rate for this recommendation is low. Additionally, there is a subset of patients who would require extended thromboprophylaxis. The majority of the studies that looked into this question consisted of patients in the surgical setting. Emerging data suggest that risk factors other than surgery can also dictate the duration of anticoagulation. While extending anticoagulation in all patients may help reduce VTE-related mortality, identifying these risk factors is important. Hence, the decision to initiate prophylaxis should be individualized, considering the overall thrombotic and bleeding risks. This review explores the relationship between IBD and VTE, including risk factors, epidemiology, and prevention. A multifactorial approach involving aggressive management of underlying inflammation, identification of modifiable risk factors, and judicious use of anticoagulant therapy is essential for reducing the burden of VTE in this vulnerable population.

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  1. Talbot RW, Heppell J, Dozois RR, et al. Vascular complications of inflammatory bowel disease. Mayo Clin Proc 1986;61(2):140–145. DOI: 10.1016/s0025-6196(12)65200-8.
  2. Webberley MJ, Hart MT, Melikian V. Thromboembolism in inflammatory bowel disease: Role of platelets. Gut 1993;34(2):247–251. DOI: 10.1136/gut.34.2.247.
  3. Yuhara H, Steinmaus C, Corley D, et al. Meta-analysis: the risk of venous thromboembolism in patients with inflammatory bowel disease. Aliment Pharmacol Ther 2013;37(10):953–962. DOI: 10.1111/apt.12294.
  4. Fumery M, Xiaocang C, Dauchet L, et al. Thromboembolic events and cardiovascular mortality in inflammatory bowel diseases: A meta-analysis of observational studies. J Crohns Colitis 2014;8(6):469–479. DOI: 10.1016/j.crohns.2013.09.021.
  5. Nguyen GC, Bernstein CN, Bitton A, et al. Consensus Statements on the risk, prevention, and treatment of venous thromboembolism in inflammatory bowel disease: Canadian Association of Gastroenterology. Gastroenterology 2014;146(3):835–848.e6. DOI: 10.1053/j.gastro.2014.01.042.
  6. Ando K, Fujiya M, Nomura Y, et al. The incidence and risk factors of venous thromboembolism in patients with inflammatory bowel disease: a prospective multicenter cohort study. Digestion 2019;100(4):229–237. DOI: 10.1159/000495289.
  7. Sonoda K, Ikeda S, Mizuta Y, et al. Evaluation of venous thromboembolism and coagulation-fibrinolysis markers in Japanese patients with inflammatory bowel disease. J Gastroenterol 2004;39(10):948–954. DOI: 10.1007/s00535-004-1426-6.
  8. Bernstein CN, Blanchard JF, Houston DS, et al. The incidence of deep venous thrombosis and pulmonary embolism among patients with inflammatory bowel disease: A population-based cohort study. Thromb Haemost 2001;85:430–434. PMID: 11307809.
  9. Kappelmann MD, Horvath-Puho E, Sandler RS, et al. Thromboembolic risk among Danish children and adults with inflammatory bowel diseases: A population-based nationwide study. Gut 2011;60(7): 937–943. DOI: 10.1136/gut.2010.228585.
  10. Grainge MJ, West J, Card TR. Venous thromboembolism during active disease and remission in inflammatory bowel disease: a cohort study. Lancet 2010;375(9715):657–663. DOI: 10.1016/S0140-6736(09)61963-2.
  11. Han Y, Zhao J, Huang H, et al. Characteristics of hemorheology in patients with acute severe ulcerative colitis and the clinical study of rivaroxaban anticoagulant therapy. Hepat Mon 2019;19:e92536. DOI: 10.5812/hepatmon.92536
  12. Danese S, Papa A, Saibeni S, et al. Inflammation and coagulation in inflammatory bowel disease: the clot thickens. Am J Gastroenterol 2007;102(1):174–186. DOI: 10.1111/j.1572-0241.2006.00943.x.
  13. Boehme MW, Autschbach F, Zuna I, et al. Elevated serum levels and reduced immunohistochemical expression of thrombomodulin in active ulcerative colitis. Gastroenterology 1997;113(1):107–117. DOI: 10.1016/s0016-5085(97)70086-6.
  14. Meucci G, Pareti F, Vecchi M, et al. Serum von Willebrand factor levels in patients with inflammatory bowel disease are related to systemic inflammation. Scand J Gastroenterol 1999;34(3):287–290. DOI: 10.1080/00365529950173708.
  15. Solem CA, Loftus EV, Tremaine WJ, et al. Venous thromboembolism in inflammatory bowel disease. Am J Gastroenterol 2004;99(1):97–101. DOI: 10.1046/j.1572-0241.2003.04026.x.
  16. Koutroubakis IE, Sfiridaki A, Tsiolakidou G, et al. Genetic risk factors in patients with inflammatory bowel disease and vascular complications: case-control study. Inflamm Bowel Dis 2007;13(4): 410–415. DOI: 10.1002/ibd.20076.
  17. Zhong M, Dong XW, Zheng Q, et al. Factor V Leiden and thrombosis in patients with inflammatory bowel disease (IBD): A meta-analysis. Thromb Res 2011;128:403–409. 2011;128(5):403–409. DOI: 10.1016/j.thromres.2011.07.014.
  18. Liang J, Wu S, Feng B, et al. Factor V Leiden and inflammatory bowel disease: a systematic review and meta-analysis. J Gastroenterol 2011;46(10):1158–1166. DOI: 10.1007/s00535-011-0441-7.
  19. Turri D, Rosselli M, Simioni P, et al. Factor V Leiden and prothrombin gene mutation in inflammatory bowel disease in a Mediterranean area. Dig Liver Dis 2001;33:559–562. DOI: 10.1016/s1590-8658(01)80107-9.
  20. Larsen TB, Nielsen JN, Fredholm L, et al. Hyperhomocysteinemia, coagulation pathway activation and thrombophilia in patients with inflammatory bowel disease. Scand J Gastroenterol. 2002;37:62–67. 2002;37(1):62–67. DOI: 10.1080/003655202753387374.
  21. Naito T, Botwin GJ, Haritunians T, et al. Prevalence and effect of genetic risk of thromboembolic disease in inflammatory bowel disease. Gastroenterology 2021;160(3):771–780.e4. DOI: 10.1053/j.gastro.2020.10.019.
  22. Heits F, Stahl M, Ludwig D, et al. Elevated serum thrombopoietin and interleukin-6 concentrations in thrombocytosis associated with inflammatory bowel disease. J Interferon Cytokine Res. 1999;19(7):757–760. DOI: 10.1089/107999099313604.
  23. Chiarantini E, Valanzano R, Liotta AA, et al. Persistence of hemostatic alterations in patients affected by Crohn's disease after bowel surgery. Thromb Res 1997;87(6):539–546. DOI: 10.1016/s0049-3848 (97)00183-7.
  24. Collins CE, Cahill MR, Newland AC, et al. Platelets circulate in an activated state in inflammatory bowel disease. Gastroenterology 1994;106(4):840–845. DOI: 10.1016/0016-5085(94)90741-2.
  25. Danese S, Fiocchi C. Platelet activation and the CD40/CD40L pathway: mechanisms and implications for human disease. Crit Rev Immunol 2005;25(2):103–121. DOI: 10.1615/critrevimmunol.v25.i2.20.
  26. Kim YH, Pfaller B, Marson A, et al. The risk of venous thromboembolism in women with inflammatory bowel disease during pregnancy and the postpartum period: A systematic review and meta-analysis. Medicine (Baltimore). 2019;98(38):e17309. DOI: 10.1097/MD.0000000000017309.
  27. Maxwell SR, Moots RJ, Kendall MJ. Corticosteroids: do they damage the cardiovascular system? Postgrad Med J 1994;70(830):863–870. DOI: 10.1136/pgmj.70.830.863.
  28. Nguyen GC, Sam J. Rising prevalence of venous thromboembolism and its impact on mortality among hospitalized inflammatory bowel disease patients. Am J Gastroenterol 2008;103(9):2272–2280. DOI: 10.1111/j.1572-0241.2008.02052.x.
  29. Ytterberg, S R, Bhatt DL, Mikuls TR, et al. Cardiovascular and cancer risk with tofacitinib in rheumatoid arthritis. N Engl J Med 2022;386(4): 316–326. DOI: 10.1056/NEJMoa2109927.
  30. Curtis JR, Yamaoka K, Chen YH, et al. Malignancy risk with tofacitinib versus TNF inhibitors in rheumatoid arthritis: Results from the open-label, randomised controlled ORAL surveillance trial. Ann. Rheumatic Dis 2023;82(3):331–343. DOI: 10.1136/ard-2022-222543.
  31. Communication, FDS FDA approves Boxed Warning about increased risk of blood clots and death with higher dose of arthritis and ulcerative colitis medicine tofacitinib (Xeljanz, Xeljanz XR); FDA Drug Safety Communication; 2019.
  32. Sandborn WJ, Panés J, Sands BE, et al. Venous thromboembolic events in the tofacitinib ulcerative colitis clinical development programme. Aliment Pharmacol Ther 2019;50(10):1068–1076. DOI: 10.1111/apt.15514.
  33. Zhang J, Li W, Gong M, et al. Risk of venous thromboembolism with Janus kinase inhibitors in inflammatory immune diseases: A systematic review and meta-analysis. Front Pharmacol 2023;14:1189389. DOI: 10.3389/fphar.2023.1189389.
  34. Campanaro F, Zaffaroni A, Cacioppo E, et al. Venous and arterial thromboembolic risk of JAK inhibitors: A systematic review with meta-analysis. Rheumatology (Oxford). 2023;62(10):3245–3255. DOI: 10.1093/rheumatology/kead211.
  35. Novacek G, Weltermann A, Sobala A, et al. Inflammatory bowel disease is a risk factor for recurrent venous thromboembolism. Gastroenterology 2010;139(3):779–787.e1. DOI: 10.1053/j.gastro. 2010.05.026.
  36. Ra G, Thanabalan R, Ratneswaran S, et al. Predictors and safety of venous thromboembolism prophylaxis among hospitalized inflammatory bowel disease patients. J Crohns Colitis 2013;7(10):e479–e485. DOI: 10.1016/j.crohns.2013.03.002.
  37. Tinsley A, Naymagon S, Trindade AJ, et al. A survey of current practice of venous thromboembolism prophylaxis in hospitalized inflammatory bowel disease patients in the United States. J Clin Gastroenterol 2013;47(1):e1–e6. DOI: 10.1097/MCG.0b013e31824c0dea.
  38. Ananthakrishnan AN, Cagan A, Gainer VS, et al. Thromboprophylaxis is associated with reduced post-hospitalization venous thromboembolic events in patients with inflammatory bowel diseases. Clin Gastroenterol Hepatol 2014;12(11):1905–1910. DOI: 10.1016/j.cgh.2014.02.034.
  39. Brady MT, Patts GJ, Rosen A, et al. Postoperative venous thromboembolism in patients undergoing abdominal surgery for IBD: A common but rarely addressed problem. Dis Colon Rectum 2017;60(1):61–67. DOI: 10.1097/DCR.0000000000000721.
  40. Benlice C, Holubar SD, Gorgun E, et al. Extended venous thromboembolism prophylaxis after elective surgery for IBD patients: nomogram-based risk assessment and prediction from nationwide cohort. Dis Colon Rectum 2018;61(10):1170–1179. DOI: 10.1097/DCR.0000000000001189.
  41. Kaddourah O, Numan L, Jeepalyam S, et al. Venous thromboembolism prophylaxis in inflammatory bowel disease flare-ups. Ann Gastroenterol 2019;32(6):578–583. DOI: 10.20524/aog.2019.0412.
  42. Faye AS, Wen T, Ananthakrishnan AN, et al. Acute venous thromboembolism risk highest within 60 days after discharge from the hospital in patients with inflammatory bowel diseases. Clin Gastroenterol Hepatol 2020;18(5):1133–1141.e3. DOI: 10.1016/j.cgh.2019.07.028.
  43. McKechnie T, Wang J, Springer JE, et al. Extended thromboprophylaxis following colorectal surgery in patients with inflammatory bowel disease: a comprehensive systematic clinical review. Colorectal Dis 2020;22(6):663–678. DOI: 10.1111/codi.14853.
  44. Stubbs JM, Assareh H, Curnow J, et al. Incidence of in-hospital and post-discharge diagnosed hospital-associated venous thromboembolism using linked administrative data. Intern Med J 2018;48(2):157–165. DOI: 10.1111/imj.13679.
  45. Ambra N, Mohammad OH, Naushad VA, et al. Venous thromboembolism among hospitalized patients: incidence and adequacy of thromboprophylaxis – A retrospective study. Vasc Health Risk Manag 2022;18:575–587. DOI: 10.2147/VHRM.S370344.
  46. Shen J, Ran ZH, Tong JL, et al. Meta-analysis: the utility and safety of heparin in the treatment of active ulcerative colitis. Aliment Pharmacol Ther 2007;26(5):653–663. DOI: 10.1111/j.1365-2036.2007.03418.x.
  47. Schünemann HJ, Cushman M, Burnett AE, et al. American Society of Hematology 2018 guidelines for management of venous thromboembolism: prophylaxis for hospitalized and nonhospitalized medical patients. Blood Adv 2018;2(22):3198–3225. DOI: 10.1182/bloodadvances.2018022954.
  48. Dwyer JP, Javed A, Hair CS, et al. Venous thromboembolism and underutilisation of anticoagulant thromboprophylaxis in hospitalized patients with inflammatory bowel disease. Intern Med J 2014;44(8):779–784. DOI: 10.1111/imj.12488.
  49. Wallaert JB, De Martino RR, Marsicovetere PS, et al. Venous thromboembolism after surgery for inflammatory bowel disease: Are there modifiable risk factors? Data from ACS NSQIP. Dis Colon Rectum 2012;55(11):1138–1144. DOI: 10.1097/DCR.0b013e3182698f60.
  50. Olivera PA, Zuily S, Kotze PG, et al. International consensus on the prevention of venous and arterial thrombotic events in patients with inflammatory bowel disease. Nat Rev Gastroenterol Hepatol 2021;18(12):857–873. DOI: 10.1038/s41575-021-00492-8.
  51. Carty E, Rampton DS. Evaluation of new therapies for inflammatory bowel disease. Br J Clin Pharmacol 2003;56(4):351–361. DOI: 10.1046/j.1365-2125.2003.01965.x.
  52. Ang YS, Mahmud N, White B, et al. Randomized comparison of unfractionated heparin with corticosteroids in severe active inflammatory bowel disease. Aliment Pharmacol Ther 2000;14(8): 1015–1022. DOI: 10.1046/j.1365-2036.2000.00802.x.
  53. Kahn SR, Lim W, Dunn AS, et al. Prevention of VTE in nonsurgical patients: Antithrombotic Therapy and Prevention of Thrombosis, 9th edition, American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012;141:e195S–e226S. DOI: 10.1378/chest.11-2296.
  54. Mowat C, Cole A, Windsor A, et al. Guidelines for the management of inflammatory bowel disease in adults. Gut 2011;60(5):571–607. DOI: 10.1136/gut.2010.224154.
  55. Junqueira DR, Zorzela LM, Perini E. Unfractionated heparin versus low-molecular weight heparins for avoiding heparin-induced thrombocytopenia in postoperative patients. Cochrane Database Syst Rev. 2017;4:CD007557. DOI: 10.1002/14651858.CD007557.pub3.
  56. Kumar A, Talwar A, Farley JF, et al. Fondaparinux sodium compared with low-molecular-weight heparins for perioperative surgical thromboprophylaxis: a systematic review and meta-analysis. J Am Heart Assoc 2019;8(10):e012184. DOI: 10.1161/JAHA.119.012184.
  57. Goldhaber SZ, Leizorovicz A, Kakkar AK, et al. Apixaban versus enoxaparin for thromboprophylaxis in medically ill patients. N Engl J Med 2011;365(23):2167–2177. DOI: 10.1056/NEJMoa1110899.
  58. Riva N, Ageno W. Direct oral anticoagulants for unusual-site venous thromboembolism. Res Pract Thromb Haemost 2021;5:265–277. DOI: 10.1002/rth2.12480.
  59. Neumann I, Izcovich A, Zhang Y, et al. DOACs vs LMWHs in hospitalized medical patients: a systematic review and meta-analysis that informed 2018 ASH guidelines. Blood Adv 2020;4(7):1512–1517. DOI: 10.1182/bloodadvances.2019000840.
  60. Tøttrup A, Erichsen R, Sværke C, et al. Thirty-day mortality after elective and emergency total colectomy in Danish patients with inflammatory bowel disease: A population-based nationwide cohort study. BMJ Open 2012;2:e000823. DOI: 10.1136/bmjopen-2012-000823.
  61. Chu TPC, Grainge MJ, Card TR. The risk of venous thromboembolism during and after hospitalization in patients with inflammatory bowel disease activity. Aliment Pharmacol Ther 2018;48(10):1099–1108. DOI: 10.1111/apt.15010.
  62. Trepanier M, Alhassan N, Sabapathy CA, et al. Cost-effectiveness of extended thromboprophylaxis in patients undergoing colorectal surgery from a Canadian Health Care System perspective. Dis Colon Rectum 2019;62(11):1381–1389. DOI: 10.1097/DCR.0000000000001438.
  63. Nguyen GC, Bernstein CN. Duration of anticoagulation for the management of venous thromboembolism in inflammatory bowel disease: a decision analysis. Am J Gastroenterol 2013;108(9): 1486–1495. DOI: 10.1038/ajg.2013.220.
  64. Leeds IL, Dibrito SR, Canner JK, et al. Cost-benefit limitations of extended, outpatient venous thromboembolism prophylaxis following surgery for Crohn's disease. Dis Colon Rectum 2019;62(11):1371–1380. DOI: 10.1097/DCR.0000000000001461.
  65. McCurdy JD, Israel A, Hasan M, et al. A clinical predictive model for post-hospitalization venous thromboembolism in patients with inflammatory bowel disease. Aliment Pharmacol Ther 2019;49(12):1493–1501. DOI: 10.1111/apt.15286.
  66. Sultan K, Shah D, Bhorania K, et al. Increased transfusion requirements with pharmacologic thromboembolism prophylaxis during inflammatory bowel disease exacerbation. Dig Dis Sci 2019;64(11):3256–3262. DOI: 10.1007/s10620-019-05650-2.
  67. Scharrer S, Primas C, Eichinger S, et al; Austrian IBD Study Group. Inflammatory bowel disease and risk of major bleeding during anticoagulation for venous thromboembolism. Inflamm Bowel Dis 2021;27(11):1773–1783. DOI: 10.1093/ibd/izaa337.
  68. Story E, Bijelic V, Penney C, et al. Safety of venous thromboprophylaxis with low-molecular-weight heparin in children with ulcerative colitis. J Pediatr Gastroenterol Nutr 2021;73(5):604–609. DOI:10.1097/MPG.0000000000003231.
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