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The risk of venous thromboembolism during and after hospitalisation in patients with inflammatory bowel disease activity

Chu, Thomas P. C.; Grainge, Matthew J.; Card, Timothy R.

Authors

Thomas P. C. Chu thomas.chu@nottingham.ac.uk

Dr TIM CARD tim.card@nottingham.ac.uk
Clinical Associate Professor



Abstract

Background: Inflammatory bowel disease (IBD) increases the risk of venous thromboembolism.
Aim: To determine when patients are at high risk of thromboembolic events, including after major surgery, and to guide timing of thromboprophylaxis.
Methods: Each inflammatory bowel disease patient from Clinical Practice Research Datalink, linked with Hospital Episode Statistics, was matched to up to five non-IBD patients in this cohort study. We examined their risk of thromboembolism in hospital and within six weeks after leaving hospital, with or without undergoing major surgery, and while ambulant. Hazard ratios were estimated using Cox regression, with adjustment for age, sex, body mass index, smoking and history of malignancy or thromboembolism.
Results: Overall 23,046 inflammatory bowel disease patients had a thromboembolic risk 1.74 times (95% CI = 1.55–1.96) higher than 106,795 non-IBD patients. Among ambulant patients, the thromboembolic risk was raised during acute (hazard ratio = 3.94, 2.79–5.57) or chronic disease activity (3.97, 2.90–5.45) but their absolute risk remained below 5/1000 person-years. The hazard ratio for thromboembolism among in-patients not undergoing major surgery was 1.13 (0.63–2.02), compared to 2.43 (1.20–4.92) among surgical patients, with a near doubling of absolute risk associated with surgery (59.5/1000 person-years, compared with 31.1 without surgery). The absolute risk remained elevated within six weeks after leaving hospital (18.6/1000 person-years in inflammatory bowel disease patients after surgery).
Conclusions: Inflammatory bowel disease patients are at an increased risk of venous thromboembolism. Absolute risks are raised during active disease, when in hospital, and after leaving hospital following major surgery.

Citation

Chu, T. P. C., Grainge, M. J., & Card, T. R. (2018). The risk of venous thromboembolism during and after hospitalisation in patients with inflammatory bowel disease activity. Alimentary Pharmacology and Therapeutics, 48(10), 1099-1108. doi:10.1111/apt.15010

Journal Article Type Article
Acceptance Date Sep 13, 2018
Online Publication Date Oct 8, 2018
Publication Date 2018-11
Deposit Date Oct 10, 2018
Publicly Available Date Oct 9, 2019
Journal Alimentary Pharmacology & Therapeutics
Print ISSN 0269-2813
Electronic ISSN 1365-2036
Publisher Wiley
Peer Reviewed Peer Reviewed
Volume 48
Issue 10
Pages 1099-1108
DOI https://doi.org/10.1111/apt.15010
Keywords inflammatory bowel diseases, embolism and thrombosis, hospitalization, risk factors
Public URL https://nottingham-repository.worktribe.com/output/1156823
Publisher URL https://onlinelibrary.wiley.com/doi/abs/10.1111/apt.15010
Additional Information This is the peer reviewed version of the following article: Thomas P. C. Chu, Matthew J. Grainge, Timothy R. Card, The risk of venous thromboembolism during and after hospitalisation in patients with inflammatory bowel disease activity, Alimentary Pharmacology & Therapeutics, which has been published in final form at doi:10.1111/apt.15010. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions.

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