After Surgery, IBD Is a Risk Factor for Blood Clots

Jim Kling

October 17, 2011

October 17, 2011 — Patients with inflammatory bowel disease (IBD) are at greater risk for postoperative deep vein thrombosis (DVT) and pulmonary embolism (PE), according to a study published online October 17 in the Archives of Surgery.

Patients with IBD have long been known to be more likely to develop thromboembolic complications, especially DVT and PE. Patients with IBD are at increased risk for venous thromboembolism, and there is also evidence that patients with IBD who have PE also are at increased risk for death.

However, DVT and PE prophylaxis guidelines make no mention of patients with IBD.

Andrea Merrill, MD, from Massachusetts General Hospital, and Frederick Millham, MD, from Newton Wellesley Hospital, Boston, designed a retrospective study to examine whether these trends occur in patients undergoing surgery at American College of Surgeons National Surgical Quality Improvement Program member hospitals.

The study included 211 member hospitals and 271,368 surgical patients. Of these patients, 2249 were diagnosed with IBD (0.8%). These patients were compared with 269,119 patients without IBD. The researchers determined the incidence of DVT, PE, myocardial infarction, and stroke within 30 days of surgery.

In the entire sample, the researchers found 2665 cases of DVT or PE (1.0%). The incidence of PE was higher in patients with IBD (2.5%; P < .001). There also was a higher rate of DVT or PE among patients with IBD in nonintestinal surgical cases (5.0%; P = .002). When confounders were accounted for in a regression analysis, the researchers confirmed the association between IBD and increased risk for DVT or PE (odds ratio, 2.03; 95% confidence interval, 1.52 - 2.70). For nonintestinal surgery, the odds ratio was 4.45 (95% confidence interval, 1.72 - 11.49).

The researchers found no increased risk among patients with IBD for postoperative myocardial infarction or stroke.

"These findings suggest that standard DVT and PE prophylaxis should be reconsidered for [patients with IBD]," authors write.

The authors have disclosed no relevant financial relationships.

Arch Surg. Published online October 17, 2011. Abstract

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