Evidence Review
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Oct 28, 2021; 27(40): 6757-6774
Published online Oct 28, 2021. doi: 10.3748/wjg.v27.i40.6757
Venous and arterial thromboembolism in patients with inflammatory bowel diseases
Antoni Stadnicki, Izabela Stadnicka
Antoni Stadnicki, Department of Physiology, Faculty of Medicine, University of Technology, Katowice 41-209, Poland
Izabela Stadnicka, Department of Molecular Medicine, Medical University of Silesia, Faculty of Pharmacy, Sosnowiec 41-200, Poland
Author contributions: Both authors designated the overall study, collected information, drafted the manuscript, revised the manuscript critically, and approved the final version of manuscript.
Conflict-of-interest statement: Authors declare no conflict of interests and no financial support for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Antoni Stadnicki, DSc, MD, PhD, Professor, Department of Physiology, Faculty of Medicine, University of Technology, Ul. Rolna, Katowice 41-209, Poland. astadnic@wp.pl
Received: March 29, 2021
Peer-review started: March 29, 2021
First decision: June 14, 2021
Revised: June 22, 2021
Accepted: August 19, 2021
Article in press: August 19, 2021
Published online: October 28, 2021
Processing time: 211 Days and 22.7 Hours
Abstract

The risk of thromboembolism (TE) is increased in patients with inflammatory bowel disease (IBD), mainly due to an increased risk of venous TE (VTE). The risk of arterial TE (ATE) is less pronounced, but an increased risk of cardiovascular diseases needs to be addressed in IBD patients. IBD predisposes to arterial and venous thrombosis through similar prothrombotic mechanisms, including triggering activation of coagulation, in part mediated by impairment of the intestinal barrier and released bacterial components. VTE in IBD has clinical specificities, i.e., an earlier first episode in life, high rates during both active and remission stages, higher recurrence rates, and poor prognosis. The increased likelihood of VTE in IBD patients may be related to surgery, the use of medications such as corticosteroids or tofacitinib, whereas infliximab is antithrombotic. Long-term complications of VTE can include post-thrombotic syndrome and high recurrence rate during post-hospital discharge. A global clot lysis assay may be useful in identifying patients with IBD who are at risk for TE. Many VTEs occur in IBD outpatients; therefore, outpatient prophylaxis in high-risk patients is recommended. It is crucial to continue focusing on prevention and adequate treatment of VTE in patients with IBD.

Keywords: Inflammatory bowel disease; Thrombosis; Coagulation; Bacterial components; Prophylaxis; Post-thrombotic syndrome

Core Tip: Patients with inflammatory bowel disease (IBD) are at significantly higher risk for venous thromboembolism (VTE) than patients with other inflammatory and immune-mediated diseases. The prevalence of arterial vascular disease is also higher in IBD. Inflammatory and molecular aspects of coagulation cascades are strictly linked and share several common mediators, including bacterial components as a possible link between intestinal microbiota and coagulation. We explored risk factors of thrombosis in IBD including clinical specificity, fibrin clot phenotype, Clostridium difficile infection, medication and surgery. We also present long-lasting thromboembolic complications and consider the advantage of post-discharge VTE prophylaxis.