Venous Thromboembolism Increasing in Inflammatory Bowel Disease Hospitalizations

From 2000 to 2018, the rate of venous thromboembolism in patients hospitalized with IBD increased from 192 to 295 cases per 10,000 hospitalizations.

The rate of venous thromboembolism (VTE)-related hospitalizations in patients with inflammatory bowel disease (IBD) is increasing, according to study results published in Alimentary Pharmacology and Therapeutics.

Researchers sourced data from the US Nationwide Inpatient Sample from 2000 to 2018 and used diagnosis codes to identify VTE-associated hospitalizations in patients with IBD. Additional patient and disease characteristics, such as age, sex, race, chronic steroid use, and IBD subtype were also noted.

The primary outcome was the rate of VTE-associated hospitalizations between 2000 and 2018. Secondary outcomes included risk factors for VTE-associated hospitalization, rate of VTE-associated mortality, and risk factors for mortality in patients hospitalized with a VTE.

Researchers identified 4,859,728 hospitalizations among patients with IBD — 128,236 of which were associated with a VTE. The rate of VTE-associated hospitalizations increased from 192 to 295 cases per 10,000 hospitalizations (average annual percent change [AAPC], 2.4%; 95% CI, 1.4%-3.4%; P <0.001). The increased rate remained statistically significant when stratified by Crohn disease (170-260 cases; AAPC, 2.7%; 95% CI, 1.4%-4.0%; P <.001) vs ulcerative colitis (202-259 cases; AAPC, 1.8%; 95% CI, 0.9%-2.7%; P <.001). Mortality rates among all patients hospitalized with IBD did not significantly change over time.

“As the IBD patient population is [aging], this rate may continue to increase, further [emphasizing] the need for continued education regarding the elevated risk of VTE in IBD, as well as the safety of pharmacologic prophylaxis use.”

Independent risk factors for VTE-associated hospitalization included older age, male sex, identifying as non-Hispanic Black vs non-Hispanic White, having Clostridioides difficile or a colonoscopy during hospitalization, and a history of chronic steroid use. A multivariable analysis indicated that prior VTE or thrombophilia was associated with the highest likelihood of VTE-related hospitalization.

Study limitations include an inability to obtain more specific data regarding medications, such as biologics or VTE prophylaxis use; an inability to confirm the accuracy of outcomes and variables extracted from databases; and the cross-sectional design.

“We found that the rate of VTE increased over the past [2] decades, without significant improvement in mortality,” the study authors wrote. “As the IBD patient population is [aging], this rate may continue to increase, further [emphasizing] the need for continued education regarding the elevated risk of VTE in IBD, as well as the safety of pharmacologic prophylaxis use.”

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Pleases see the original reference for a full list of authors’ disclosures.

References:

Faye AS, Lee KE, Dodson J, et al. Increasing rates of venous thromboembolism among hospitalised patients with inflammatory bowel disease: a nationwide analysis. Aliment Pharmacol Ther. 2022;56(7):1157-1167. doi:10.1111/apt.17162