Unawareness of thromboprophylaxis is associated with low venous thromboembolism occurrence in hospitalized patients with acute inflammatory bowel disease flare

Background: Inflammatory bowel disease (IBD) is a set of chronic inflammatory diseases associated with significant morbidity. Generally, IBD patients have twice the risk of venous thromboembolism (VTE) compared to healthy controls. VTE can occur both, during hospital stay or after discharge. We aimed to assess the incidence among IBD patients who were hospitalized for disease exacerbation.

Methods: In a retrospective crosssectional analysis all IBD patients who were admitted with disease exacerbation at Galilee Medical Center and Hadassah Medical Organization were included in the study. Excluding criteria was IBD with already known hypercoagulable state.

Results: One-hundred and sixteen patients with 176 admissions due to IBD flare were included in the study. The average age was 38.3±16.3 years. Sixty-six admissions (37.5%) occurred in patients with ulcerative colitis exacerbation and 110 in patients with Crohn's disease exacerbation (62.5%). Thirty-nine patients (22.1%) were smokers. Fifty-four patients (30.7%) and 68 patients (38.6%) were on previous (within 3 months) biological and steroid treatment, respectively. Twelve patients (6.8%) were on prophylactic subcutaneous anticoagulation (enoxaparin) throughout their hospital stay and only 3 patient (1.7%) developed inhospital clinical VTE episode. The mean hospitalization length was 6.8±7.9 days and among patients who developed VTE episode, the length of stay was significantly higher as compared to patients without VTE episodes (36.7 vs. 6.3 days, P<0.0001). Notably, inhospital IBD related-surgical procedure was the only risk factor for the development of VTE (Odds Ratio: 36.2; P=0.01).

Conclusions: In-hospital VTE is rare among IBD patients admitted with exacerbation. Further studies are warranted to assess risk factors for inhospital VTE development and to assess further the role of prophylactic anticoagulation among IBD patients with bloody diarrhea.