Hospitalized patients with IBD experienced greater adjusted odds of deep vein thrombosis, pulmonary embolism, portal vein thrombosis, and mesenteric ischemia.

“The incidence of thrombotic events is three-fold to four-fold higher in patients with IBD compared with patients without IBD,” notes Alfred D. Nelson, MD.

However, while some research from the National Inpatient Sample (NIS)—the most extensive publicly available all-payer inpatient database in the United States—has assessed this association, stratification for Crohn’s disease and ulcerative colitis in bigger studies is limited, according to the study results.

“The aims of this study were to utilize the NIS database to describe the occurrence of thromboembolic events among inpatients with IBD versus inpatients without IBD and to assess inpatient outcomes, such as morbidity, mortality, and resource utilization, in patients with IBD and thromboembolic events, stratified by IBD subtype,” Dr. Nelson says.

For a study published in Digestive Diseases and Sciences, Dr. Nelson and colleagues assessed 2016 data from the NIS. Patients with thromboembolic events were identified with diagnostic ICD codes and classified into four categories: deep vein thrombosis (DVT); pulmonary embolism (PE); portal vein thrombosis (PVT); and mesenteric ischemia. The researchers then sub-stratified patients according to a diagnosis of Crohn’s disease or ulcerative colitis.

The inpatient prevalence and odds of thromboembolic events in patients with versus without IBD served as the primary outcome; secondary outcomes included inpatient morbidity, mortality, resource utilization, colectomy rates, hospital length of stay, and total hospital costs and charges compared with patients with IBD and thromboembolic events.

Venous Thromboembolic Events Higher in IBD Population
The researchers identified and assessed 331,950 admissions for patients with IBD (mean age, 51.6; 55.8% female). Most patients (62.4%) had Crohn’s disease; the remaining percentage of patients (37.6%) had ulcerative colitis.

Among patients with IBD, 3.8% experienced a related thromboembolic event. In terms of the primary outcome, inpatients with IBD had greater adjusted odds of DVT (adjusted OR [aOR], 1.59; P<0.001), PE (aOR, 1.20; P<0.001), PVT (aOR, 3.18; P<0.001), and mesenteric ischemia (aOR, 2.49; P<0.001) versus inpatients without IBD. This association was observed in both patients with Crohn’s disease and ulcerative colitis.

“We confirmed that hospitalized patients with IBD had higher odds of experiencing a venous thromboembolic event, in addition to related mortality and resource utilization,” Dr. Nelson says. “The mortality, morbidity, odds of colectomy, and resource utilization in hospitalized patients with IBD were also significantly higher in patients who had mesenteric ischemia when compared with DVT, PE, and PVT.”

Additionally, among patients whose primary diagnosis for hospital admission was IBD, added costs, charges, and length of stay were significantly greater in those who experienced DVT and PE, he notes (Table).

Implications for Education & Future Research
The findings quantify “the extent of the link between IBD and specific thromboembolic complications,” according to Dr. Nelson, and indicate “the catastrophic consequences of a potentially preventable entity in hospitalized patients with IBD.”

He says the results illustrate the need to raise awareness of the association between IBD and thromboembolic events not only among gastroenterologists, but all medical professionals caring for hospitalized patients with IBD.

“Future research should focus on developing clinical trials that use different anticoagulant agents as prophylaxis for thromboembolic events in hospitalized patients with IBD,” Dr. Nelson notes. “Additional efforts should focus on developing structured preventative strategies during hospital admission and throughout the hospital course in patients with IBD.”