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

Sidharth Harindranath, Jijo Varghese, Shivaraj Afzalpurkar, Suprabhat Giri
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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.

How to cite this article: Harindranath S, Varghese J, Afzalpurkar S, et al. Standard and Extended Thromboprophylaxis in Patients with Inflammatory Bowel Disease: A Literature Review. Euroasian J Hepato-Gastroenterol 2023;13(2):133-141.

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炎症性肠病患者的标准和扩展血栓预防:文献综述。
炎症性肠病(IBD)(包括克罗恩病和溃疡性结肠炎)患者经常会发生静脉血栓栓塞(VTE),这是一种潜在的致命后果。导致 VTE 的病理生理机制包括炎症、凝血因子改变、内皮功能障碍和血小板活化。许多促炎细胞因子和标志物,如肿瘤坏死因子-α 和白细胞介素-6,对血栓形成级联过程有重大影响。由于各种原因,IBD 患者更容易发生 VTE。原有疾病的加重、入院、手术干预、固定、皮质类固醇的使用、中心静脉导管插入以及遗传易感性都属于此类。IBD 患者 VTE 的主要治疗方法包括抗凝治疗,根据血栓形成部位、严重程度、出血风险以及与其他药物的相互作用,对每位患者进行个体化治疗。对于某些高风险 IBD 患者,如接受大手术或因严重疾病发作而住院的患者,预防性抗凝治疗可能会起到一定作用。然而,这一建议的接受率很低。此外,还有一部分患者需要延长血栓预防期。对这一问题进行研究的大多数都是手术患者。新的数据表明,手术以外的风险因素也会决定抗凝治疗的持续时间。虽然延长所有患者的抗凝时间有助于降低 VTE 相关死亡率,但识别这些风险因素非常重要。因此,考虑到整体血栓形成和出血风险,启动预防性治疗的决定应因人而异。本综述探讨了 IBD 与 VTE 之间的关系,包括风险因素、流行病学和预防。积极治疗潜在炎症、识别可改变的风险因素以及合理使用抗凝疗法等多因素方法对于减轻这一易患人群的 VTE 负担至关重要:Harindranath S, Varghese J, Afzalpurkar S, et al:文献综述。Euroasian J Hepato-Gastroenterol 2023;13(2):133-141.
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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