Spectrum of venous thromboembolism in adult patients with ulcerative colitis in Pakistan: A single center retrospective study

Abstract

BACKGROUND

Patients with inflammatory bowel disease are at a 2-8-fold higher risk of developing venous thromboembolism (VTE) as compared to the general population. Although the exact pathogenesis is unclear, the literature suggests that increased risk of thromboembolic events in such patients occurs as a result of increased coagulation factors, inflammatory cytokines, and reduction in anticoagulants leading to a prothrombotic state.

AIM

To assess the prevalence, risk factors, management, and outcome of ulcerative colitis (UC) patients who develop VTE.

METHODS

This was a retrospective chart review done in The Gastroenterology Department of The Aga Khan University Hospital. Data was collected from medical records for all patients admitted with a diagnosis of UC from January 2012 to December 2022.

RESULTS

Seventy-four patients fulfilled the inclusion criteria. The mean ± SD of age at presentation of all UC patients was 45 years ± 10 years whereas for those who developed VTE, it was 47.6 years ± 14.7 years. Hypertension and diabetes were the most common co-morbid seen among UC patients with a frequency of 17 (22.9%) and 12 (16.2%), respectively. A total of 5 (6.7%) patients developed VTE. Deep venous thrombosis was the most common thromboembolic phenomenon seen in 3 (60%) patients. All the patients with UC and concomitant VTE were discharged home (5; 100%).

CONCLUSION

The prevalence of VTE with UC in Pakistani patients corresponds with the international literature. However, multi-centric studies are required to further explore these results.

Keywords: Deep venous thrombosis; Inflammatory bowel disease; Low-middle-income country; Anticoagulation; Protein C deficiency

Core Tip: This study highlights the paucity of data available on prevalence of venous thromboembolism in patients with ulcerative colitis (UC) in a low to middle income setting. Although previous studies have shown that patients with acute flare of UC were likely to develop thromboembolism, our data suggests otherwise. Furthermore, this study opens up a new question regarding whether UC is associated with thrombophilic conditions such as protein C deficiency.