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World J Gastroenterol. May 7, 2014; 20(17): 4857-4872
Published online May 7, 2014. doi: 10.3748/wjg.v20.i17.4857
Venous thrombosis and prothrombotic factors in inflammatory bowel disease
Fernando Magro, João-Bruno Soares, Dália Fernandes
Fernando Magro, Gastroenterology Department of Centro Hospitalar São João, 4200-319 Porto, Portugal
Fernando Magro, Institute of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
Fernando Magro, IBMC, Institute for Molecular and Cell Biology, University of Porto, 4150-180 Porto, Portugal
João-Bruno Soares, Dália Fernandes, Gastroenterology Department of Hospital de Braga, 4710-243 Braga, Portugal
Dália Fernandes, Gastroenterology Department of Centro Hospitalar da Cova da Beira, 6200-251 Covilhã, Portugal
Author contributions: Magro F and Soares JB contributed equally to this work; Magro F and Soares JB contributed to the conception and design, acquisition, analysis and interpretation of data, drafting and revising of the article for important intellectual content and final approval of the version to be published; Fernandes D contributed to the acquisition, analysis and interpretation of data, drafting of the article and final approval of the version to be published.
Correspondence to: Fernando Magro, MD, PhD, Institute of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, Al. Prof. Hernâni Monteiro, 4200-319 Porto, Portugal. fm@med.up.pt
Telephone: +351-22-5513600 Fax: +351-22-5513601
Received: September 29, 2013
Revised: January 12, 2014
Accepted: March 12, 2014
Published online: May 7, 2014
Processing time: 220 Days and 8.8 Hours
Abstract

Patients with inflammatory bowel disease (IBD) may have an increased risk of venous thrombosis (VTE). PubMed, ISI Web of Knowledge and Scopus were searched to identify studies investigating the risk of VTE and the prevalence of acquired and genetic VTE risk factors and prothrombotic abnormalities in IBD. Overall, IBD patients have a two- to fourfold increased risk of VTE compared with healthy controls, with an overall incidence rate of 1%-8%. The majority of studies did not show significant differences in the risk of VTE between Crohn’s disease and ulcerative colitis. Several acquired factors are responsible for the increased risk of VTE in IBD: inflammatory activity, hospitalisation, surgery, pregnancy, disease phenotype (e.g., fistulising disease, colonic involvement and extensive involvement) and drug therapy (mainly steroids). There is also convincing evidence from basic science and from clinical and epidemiological studies that IBD is associated with several prothrombotic abnormalities, including initiation of the coagulation system, downregulation of natural anticoagulant mechanisms, impairment of fibrinolysis, increased platelet count and reactivity and dysfunction of the endothelium. Classical genetic alterations are not generally found more often in IBD patients than in non-IBD patients, suggesting that genetics does not explain the greater risk of VTE in these patients. IBD VTE may have clinical specificities, namely an earlier first episode of VTE in life, high recurrence rate, decreased efficacy of some drugs in preventing further episodes and poor prognosis. Clinicians should be aware of these risks, and adequate prophylactic actions should be taken in patients who have disease activity, are hospitalised, are submitted to surgery or are undergoing treatment.

Keywords: Acquired; Genetic; Prothrombotic; Venous thrombosis; Risk of venous thrombosis; Inflammatory bowel disease

Core tip: In inflammatory bowel disease (IBD), there is an increased risk of venous thrombosis (VTE) due to inflammatory activity, hospitalisation, surgery, pregnancy, disease phenotype and drug therapy. Classical genetic alterations are not generally found more often in IBD patients than in non-IBD patients, suggesting that genetics does not explain the greater risk of VTE in these patients. IBD VTE may have clinical specificities, namely an earlier first episode of VTE in life, high recurrence rate, decreased efficacy of some drugs in preventing further episodes and poor prognosis.