Venous thromboembolism in inflammatory bowel disease

Table 1 Age and venous thromboembolism risk

Ref.	Findings	Statistics
Kappelman et al[19]	IBD patients ≤ 20 are at increased risk of VTE compared to age and sex- matched non-IBD patients	Hazard ratio 6.0 (95%CI: 2.5-14.7) for DVT Hazard ratio 6.4 (95%CI: 2.0-20.3) for PE
	Annual incidence of VTE is higher in older patients than in younger patients with IBD	Age	Incidence
		≤ 20 yr	8.9/10000 persons-years
		> 60 yr	54.6/10000 persons-years
Nylund et al[20]	Hospitalized IBD children/adolescents are at increased risk of developing VTE compared to non-IBD hospitalized children/ adolescents	Relative risk 2.36 (95%CI: 2.15-2.58)
	Odds of VTE increased as age increased	Odds ratio 2.32 (95%CI: 2.26-2.38)
Ando et al[22]	IBD patients > 50 have an increased odds of developing VTE	Odds ratio 3.52 (95%CI: 1.25-9.94)
Nguyen et al[5]	Each incremental decade in age was associated with increased odds of developing VTE	Odds ratio 1.20 (95%CI: 1.15-1.25)
Faye et al[23]	Age > 30 had an increased risk of VTE readmission compared with patients younger than 18 years of age	Age (yr)	Relative risk
		31-40	2.10 (95%CI: 1.29-3.42)
		41-50	2.08 (95%CI: 1.28-3.37)
		51-65	3.74 (95%CI: 2.35-5.94)
		66-80	4.04 (95%CI: 2.54-6.44)
		> 80	3.06 (95%CI: 1.87-5.02)
McCurdy et al[24]	IBD patients > 45 have an increased odds of developing VTE post-discharge	3.76 odds ratio (95%CI: 1.80-7.89)

VTE: Venous thromboembolism; DVT: Deep vein thrombosis; IBD: Inflammatory bowel disease; PE: Pulmonary embolism.

Table 2 Pregnancy and venous thromboembolism risk

Ref.	Findings	Statistics
Hansen et al[29]	Pregnant IBD patients are at increased risk of developing VTE as compared to pregnant non-IBD patients	Relative risk 1.67 (95%CI: 1.15-2.41)
	Postpartum IBD patients are at a higher risk of developing VTE than postpartum non-IBD patients	Relative risk 2.10 (95%CI: 1.33-3.30)
	Incidence of VTE is greatest in postpartum IBD women	Group	Incidence rate
		Pregnant non-IBD	2.41 (95%CI: 2.33-2.50)
		Pregnant IBD	4.20 (95%CI: 2.83-5.58)
		Postpartum non-IBD	2.88 (95%CI: 2.72-3.04)
		Postpartum IBD	7.03 (95%CI: 3.87-10.20)
Kim et al[30]	Pregnant IBD patients are at increased risk of developing VTE as compared to non-IBD pregnant patients	Relative risk 2.13 (95%CI: 1.66-2.73)
	Postpartum IBD patients are at increased risk of developing VTE as compared to postpartum non-IBD patients	Relative risk 2.61 (95%CI: 1.84-3.69)
	UC patients are at an increased risk of developing VTE as compared to CD patients both during pregnancy and in postpartum period	Group		Relative risk
		Pregnant UC vs CD patients		2.24 (95%CI: 1.60-3.11)
		Postpartum UC vs CD patients		2.85 (95%CI: 1.79-4.52)

VTE: Venous thromboembolism; IBD: Inflammatory bowel disease; CD: Crohn’s Disease; UC: Ulcerative colitis.

Table 3 Disease activity and venous thromboembolism risk

Ref.	Findings	Statistics
Grainge et al[3]	IBD flares are associated with increased risk of developing VTE as compared to non-IBD matched controls	Hazard ratio 8.40 (95%CI: 5.50-12.80)
Hansen et al[29]	IBD flare during pregnancy is associated with increased risk of developing VTE as compared to non-IBD pregnant patients (also compared to IBD pregnant patients without a flare)	Unadjusted relative risk 2.64 (95%CI: 1.69-4.14)
Bollen et al[32]	A significant proportion of patients had active disease at the time of VTE diagnosis	60/84 (71%) patients with VTE had active disease

VTE: Venous thromboembolism; IBD: Inflammatory bowel disease.

Table 4 Hospitalization and venous thromboembolism risk

Ref.	Findings	Statistics
Grainge et al[3]	Hospitalized IBD patients (regardless of disease activity) have an increased risk of VTE	Hazard ratio 2.10 (95%CI: 1.40-3.20)
	Absolute risk of VTE in IBD patients is higher during hospitalized periods than during ambulatory periods	Group	Absolute risk
		Hospitalized	25.2/1000 person-years
		Ambulatory	1.8/1000 person-years
Nguyen et al[5]	Hospitalized IBD patients with VTE had greater mortality compared to those without VTE	Odds ratio 2.50 (95%CI: 1.83-3.43)
	Incidence of VTE in hospitalized IBD patients is increasing	Group	Percent rise in odds
		Hospitalized IBD	17% rise over 7 yr
		Hospitalized non-IBD	14% rise over 7 yr
Kim et al[35]	Hospitalized IBD patients without a disease flare had higher risk of VTE as compared to age- and sex-matched non-IBD patients	Hazard ratio 12.97 (95%CI: 8.68-19.39)

VTE: Venous thromboembolism; IBD: Inflammatory bowel disease.

Table 5 Medications and venous thromboembolism risk

Medications	Risk of VTE
5-ASA	Possible ↓
Corticosteroids	↑↑↑
Azathioprine and 6-Mercatopurine	Possible ↓
TNFα inhibitors	↓↓
Tofacitinib (10 mg twice a day)	↑

VTE: Venous thromboembolism.