Inflammatory bowel disease is a risk factor for recurrent venous thromboembolism

Gottfried Novacek, Ansgar Weltermann, Anna Sobala, Herbert Tilg, Wolfgang Petritsch, Walter Reinisch, Andreas Mayer, Thomas Haas, Arthur Kaser, Thomas Feichtenschlager, Harry Fuchssteiner, Peter Knoflach, Harald Vogelsang, Wolfgang Miehsler, Reingard Platzer, Wolfgang Tillinger, Bernhard Jaritz, Alfons Schmid, Benedikt Blaha, Clemens Dejaco, Sabine Eichinger
Gastroenterology 2010, 139 (3): 779-87, 787.e1

BACKGROUND & AIMS: Patients with inflammatory bowel disease (IBD) are at increased risk of a first venous thromboembolism (VTE), yet their risk of recurrent VTE is unknown. We performed a cohort study to determine the risk for recurrent VTE among patients with IBD compared with subjects without IBD.

METHODS: We assessed 2811 patients with IBD for a history of VTE, recruited from outpatient clinics at 14 referral centers (June 2006-December 2008). Patients with VTE before a diagnosis of IBD or those not confirmed to have VTE, cancer, or a VTE other than deep vein thrombosis or pulmonary embolism, were excluded. Recurrence rates were compared with 1255 prospectively followed patients without IBD that had a first unprovoked VTE (not triggered by trauma, surgery, or pregnancy). The primary end point was symptomatic, objectively confirmed, recurrent VTE after discontinuation of anticoagulation therapy after a first VTE.

RESULTS: Overall, of 116 IBD patients who had a history of first VTE, 86 were unprovoked. The probability of recurrence 5 years after discontinuation of anticoagulation therapy was higher among patients with IBD than patients without IBD (33.4%; 95% confidence interval [CI]: 21.8-45.0 vs 21.7%; 95% CI: 18.8-24.6; P = .01). After adjustment for potential confounders, IBD was an independent risk factor of recurrence (hazard ratio = 2.5; 95% CI: 1.4-4.2; P = .001).

CONCLUSIONS: Patients with IBD are at an increased risk of recurrent VTE compared to patients without IBD.

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