Venous thromboembolism in patients with inflammatory bowel disease: Focus on prevention and treatment

Table 1 Acquired risk factors for venous thromboembolism in inflammatory bowel disease patients and modalities for their prevention and/or treatment

Risk factor	Prevention/treatment modality
Active disease ("inflammatory burden")	Effective anti-inflammatory treatment
Smoking	Programmes for smoking cessation
Oral contraceptive use	Advise alternative methods of contraception
Hyperhomocysteinaemia	Assess the presence of vitamin deficiency (vitamins B6 and B12 and folic acid) and correct if necessary
Dehydration	Provide adequate hydration
Prolonged immobilisation	Early mobilisation, especially after surgery; graduated compression stockings or pneumatic devices
Infections	Timely diagnosis and treatment of infections
Indwelling catheters	Limit the use of venous catheters; when possible, administer oral and enteral nutrition
Obesity	Encourage weight loss (diet, exercise)
Long-distance travel	Frequent ambulation, exercise, hydration

Table 2 Published guidelines for the prevention of venous thromboembolism in inflammatory bowel disease patients

Scientific society (reference)	Recommendations	Type of population at risk
European Crohn's and Colitis Organisation (ECCO)[29]	Mechanical thromboprophylaxis and/or heparin administration (UH or LMWH)	UC
European Crohn's and Colitis Organisation (ECCO)[28]	Consider VTE prophylaxis (UH, LMWH, or fondaparinux) in all hospitalised patients	CD
British Society of Gastroenterology (BSG)[31]	Pharmacological VTE prophylaxis for hospitalised patients with severe UC	UC
American College of Gastroenterology (ACG)[30]	VTE prophylaxis with heparin for hospitalised patients with severe UC	UC
American College of Chest Physicians (ACCP)[27]	Mechanical thromboprophylaxis with GCS or IPC; anticoagulant thromboprophylaxis with LMWH, UH or fondaparinux when bleeding risk decreases	Acutely ill hospitalised medical patients at increased risk of thrombosis who are bleeding or at high risk of bleeding

GCS: Graduated compression stockings; IPC: Intermittent pneumatic compression; CD: Crohn’s disease; UC: Ulcerative colitis; VTE: Venous thromboembolism; LMWH: Low molecular-weight heparin; UH: Unfractionated heparin.