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

Abstract

Inflammatory bowel disease (IBD) patients have an increased risk of venous thromboembolism (VTE), which represents a significant cause of morbidity and mortality. The most common sites of VTE in IBD patients are the deep veins of the legs and pulmonary system, followed by the portal and mesenteric veins. However, other sites may also be involved, such as the cerebrovascular and retinal veins. The aetiology of VTE is multifactorial, including both inherited and acquired risk factors that, when simultaneously present, multiply the risk to the patient. VTE prevention involves correcting modifiable risk factors, such as disease activity, vitamin deficiency, dehydration and prolonged immobilisation. The role of mechanical and pharmacological prophylaxis against VTE using anticoagulants is also crucial. However, although guidelines recommend thromboprophylaxis for IBD patients, this method is still poorly implemented because of concerns about its safety and a lack of awareness of the magnitude of thrombotic risk in these patients. Further efforts are required to increase the rate of pharmacological prevention of VTE in IBD patients to avoid preventable morbidity and mortality.

Keywords: Anticoagulants; Inflammatory bowel disease; Low molecular weight heparin; Thromboembolic prophylaxis; Unfractionated heparin; Venous thromboembolism.

Figure 1

Computed tomography scan showing portal vein thrombosis (A) and a pulmonary embolism (B) in a patient with active ulcerative colitis.

Figure 2

Plain abdominal Rx (A) and computed tomography scan (B) showing an inferior vena cava filter placed for the prevention of recurrent pulmonary embolism in a patient with Crohn’s disease and deep venous thrombosis.