Venous and arterial thromboembolism in out-patients with inflammatory bowel disease: a single center study

Abstract

Background

Patients affected by inflammatory bowel diseases (IBD), namely Crohn's disease (CD) and ulcerative colitis (UC), are at risk for thromboembolic events (TE). Patients with active/relapsing disease and those needing hospitalization and surgery show the highest risk. The thrombotic risk in out-patients with IBD is underestimated and poorly investigated.

Objectives

to evaluate the prevalence, clinical features and risk factors for thromboembolism in IBD out-patients.

Methods

From May 2021 to September 2023, consecutive IBD out-patients were evaluated for the presence of cardiovascular risk factors (smoking, arterial hypertension, diabetes mellitus, hypercholesterolemia) and history of TE. Patients with a history of TE (including coronary heart disease, stroke, transient ischemic attack- TIA-, deep vein thrombosis- DVT-, superficial vein thrombosis- SVT-, pulmonary embolism- PE-) were studied for thrombophilia.

Results

A total of 302 IBD outpatients were included in the study (154 CD; 148 UC; mean age: 41.23 ± 17.4 years). Twenty-three patients (23/302; 7.6 %) showed a thrombotic event: 14 UC patients (14/148; 9.4 %) and 9 CD patients (9/154; 5.8 %).

Among the 23 patients with TE, we observed 12 arterial thromboses (12/23; 52.2 %), including 7 cases of Myocardial Infarction (7/12; 58.3 %), 3 Ischemic Stroke (3/12; 25 %), 2 TIA (2/12; 16.7 %); and 11 episodes of venous thromboembolism (VTE) (11/23; 47.8 %), including 7 DVT (7/11; 63.6 %), 2 SVT (2/11; 18.2 %) and 2 PE (2/11; 18.2 %).

Among the 11 VTE patients 6 were affected by UC and 5 patients were affected by CD. 5 out of 12 arterial thrombosis patients were affected by CD and 7 patients by UC.

In the univariable analysis, several predictors showed a significant association with TE, including IBD activity (OR = 4.98, 95 % CI: 1.93–12.81), arterial hypertension (OR = 4.44, 95 % CI: 1.86–10.60), hypercholesterolemia (OR = 4.68, 95 % CI: 1.38–15.92), hematologic disease (OR = 6.55, 95 % CI: 1.13–37.85).

IBD activity (OR = 7.03, 95 % CI: 2.48–19.85), arterial hypertension (OR = 3.35, 95 % CI: 1.32–8.50), hypercholesterolemia (OR = 5.06, 95 % CI: 1.21–18.77), hematologic disease (OR = 12.58, 95 % CI: 1.87–69.87) and immune disease (OR = 19.39, 95 % CI: 1.29–289.60) were significantly correlated to TE events at multivariable analysis.

Conclusions

Out-patients with IBD presented a low but not negligible risk of TE, mainly correlated to the common cardiovascular risk factors described in the general population and to the presence of immunological and hematological disease. Clinicians should not underestimate thrombotic risk in these patients.