Thromboembolic Events in Patients with Inflammatory Bowel Disease: A Comprehensive Overview Original paper

What was studied?

The paper discusses thromboembolic events (TEs) in patients with inflammatory bowel disease (IBD), specifically addressing the pathophysiology, epidemiology, and management of venous thromboembolism (VTE) and arterial thromboembolism (ATE). It explores how IBD, through chronic inflammation and altered immune responses, increases the risk of thromboembolism, particularly during disease flare-ups or post-surgery. The review further examines the underlying mechanisms that contribute to thromboembolic events in IBD patients, including the role of coagulation pathways, platelets, and various risk factors such as medication, hospitalizations, and comorbidities.

Who was studied?

The study focuses on patients with IBD, specifically those diagnosed with Crohn’s disease and ulcerative colitis. These patients were assessed in terms of their risk for developing thromboembolic events, both venous and arterial. Studies included patients from various geographical regions, including those undergoing hospitalizations and surgeries, and some specific subsets such as pregnant females and postoperative patients. The paper compares IBD patients with the general population to better understand the increased risks of VTE and ATE, focusing on demographics, disease activity, and the use of specific treatments like corticosteroids.

Most important findings

The most significant findings of this review indicate that patients with IBD are at a significantly increased risk for thromboembolic events, including deep vein thrombosis (DVT) and pulmonary embolism (PE), with a 2–3 fold higher risk compared to the general population. The risk of developing thromboembolism is notably higher during disease flare-ups, hospitalization, and post-surgical periods. Patients with IBD who are treated with corticosteroids are particularly vulnerable due to the medication’s pro-coagulant effects, which increase factors like VII, VIII, and IX in the blood, promoting thrombosis. Platelet activation is also observed in IBD patients, contributing to thromboembolic events, as evidenced by the presence of markers like CD40L and P-selectin on circulating platelets. Moreover, studies show that VTE in IBD patients tends to occur at a younger age compared to the general population, and those with IBD have a higher risk of recurrent thromboembolic events, particularly post-surgery.

Mesenteric ischemia, a rare but serious thromboembolic complication, has been linked to IBD, particularly in patients with active disease and a history of surgery. The inflammation in the intestines can lead to endothelial damage, which then activates the coagulation cascade, increasing the likelihood of thrombosis in both veins and arteries. This review also highlights the need for thromboprophylaxis, especially during hospital admissions and flare-ups of IBD, to reduce the incidence of thromboembolic complications.

Key implications

The review emphasizes the importance of recognizing the elevated risk of thromboembolic events in IBD patients and the need for tailored management strategies. Clinicians must be aware of the increased risk during flare-ups, surgeries, and with corticosteroid use, and should consider prophylactic anticoagulation therapies for hospitalized patients. This is particularly relevant in those with active disease or post-surgery. The findings also underscore the need for future research into the pathophysiology of thromboembolism in IBD, particularly to identify biomarkers that could help predict and assess thrombotic risks. The potential for platelet activation and altered coagulation in IBD calls for more targeted therapies that address both inflammation and thrombosis.