Risk for VTE was two times higher in patients with IBD than in sex- and age-matched controls.

Patients with inflammatory bowel disease (IBD) have elevated risk for venous thromboembolism (VTE) — including deep venous thrombosis (DVT) and pulmonary embolism (PE) — and possibly arterial thrombosis.

To estimate the size of that risk, researchers in Denmark conducted a population-based study of 49,799 patients with IBD (14,211 with Crohn disease, 35,229 with ulcerative colitis, and 359 with unspecified IBD) and a non-IBD comparison group of 477,504 residents matched by age and sex.

Overall, patients with IBD had a two-fold increased risk for VTE compared with the non-IBD population. Although the overall incidence rates for DVT and PE increased with age, the relative risks for patients with IBD compared with residents without IBD were higher among younger patients. Patients 20 years old with IBD had a sixfold higher risk for DVT and PE than their non-IBD counterparts. Excess risk for VTE persisted after adjusting for comorbidities such as heart failure, diabetes, myocardial infarction, and stroke, and for use of medications associated with increased risk, including hormone replacement therapy.

Comment: The most notable observation of this large population-based study is that the relative risks for VTE, DVT, and PE among IBD patients are highest in the youngest age group (20). However, the absolute risk is still low in that group. Prophylactic anticoagulation should be considered in hospitalized patients with IBD, at least in older patients for whom the absolute risk is higher. Whether outpatients with active disease should be anticoagulated is still unclear. Obviously, anticoagulation could increase the risk for bleeding and iron-deficiency anemia in patients with active disease. Certainly, those patients with IBD who have experienced previous episodes of DVT or PE should be considered for lifelong anticoagulation therapy.

Source:Journal Watch Gastroenterology