Venous thromboembolism and underutilisation of anticoagulant thromboprophylaxis in hospitalised patients with inflammatory bowel disease.
BACKGROUND
Venous thromboembolism (VTE) is a well-recognised extra-intestinal manifestation of inflammatory bowel disease (IBD). Despite the widespread support for anticoagulant prophylaxis in hospitalised IBD patients, the utilisation and efficacy in clinical practice are unknown.


AIMS
The aim of this study was to assess the prevalence and clinical features of VTE among hospitalised IBD patients and ascertain whether appropriate thromboprophylaxis had been administered.


METHODS
All patients with a discharge diagnosis of Crohn disease or ulcerative colitis and VTE were retrospectively identified using International Classification of Diseases, tenth revision codes from medical records at our institution from July 1998 to December 2009. Medical records were then reviewed for clinical history and utilisation of thromboprophylaxis. Statistical analysis was performed by Mann-Whitney test and either χ(2) tests or Fisher's exact tests.


RESULTS
Twenty-nine of 3758 (0.8%) IBD admissions suffered VTE, 13 preadmission and 16 during admission. Of these 29 admissions (in 25 patients), 24% required intensive care unit and 10% died. Of the 16 venous thrombotic events that occurred during an admission, eight (50%) did not receive anticoagulant thromboprophylaxis and eight (50%) occurred despite thromboprophylaxis. Most thromboembolism despite prophylaxis occurred post-intestinal resection (n = 5, 63%).


CONCLUSION
Thromboprophylaxis is underutilised in half of IBD patients suffering VTE. Prescription of thromboprophylaxis for all hospitalised IBD patients, including dual pharmacological and mechanical prophylaxis in postoperative patients, may lead to a reduction in this preventable complication of IBD.
['Dwyer|J P|JP|', 'Javed|A|A|', 'Hair|C S|CS|', 'Moore|G T|GT|']
D000328:Adult D000368:Aged D000925:Anticoagulants D005260:Female D005500:Follow-Up Studies D006760:Hospitalization D006801:Humans D015212:Inflammatory Bowel Diseases D007297:Inpatients D008297:Male D008875:Middle Aged D015995:Prevalence D012189:Retrospective Studies D012307:Risk Factors D015912:Thrombolytic Therapy D016896:Treatment Outcome D054556:Venous Thromboembolism D014739:Victoria
venous thromboembolism anticoagulant inflammatory bowel disease Crohn disease ulcerative colitis