Inflammatory Bowel Disease Therapy and Venous Thromboembolism
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Inflammatory Bowel Disease (G Lichtenstein, Section Editor)
Inflammatory Bowel Disease Therapy and Venous Thromboembolism Thomas Lambin, MD1,2,* Adam S. Faye, MD3 Jean-Frédéric Colombel, MD2 Address 1 Gastroenterology Department, CHU de Lille – Hôpital Claude Huriez, Université de Lille, Rue Michel Polonovski, 59037, Lille, France *,2 The Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA Email: [email protected] 3 Department of Medicine, New York-Presbyterian Columbia University Medical Center, New York, NY, USA
* Springer Science+Business Media, LLC, part of Springer Nature 2020
This article is part of the Topical Collection on Inflammatory Bowel Disease Thomas Lambin and Adam S. Faye are co-first authors Keywords Venous thromboembolism I Deep venous thrombosis I Pulmonary embolism I Corticosteroids I Immunomodulators Abbreviation CD Crohn’s disease CI Confidence interval DVT Deep venous thrombosis FDA Food and Drug _ _ _ Administration pRBC Packed red blood cells PE Pulmonary embolism RA Rheumatoid arthritis TNF Tumor _ _ _ _ necrosis factor UC Ulcerative colitis VTE Venous thromboembolism 5-ASA Aminosalicylates
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Abstract Purpose of review To explore the relationship between IBD (inflammatory bowel diseases) therapy and VTE (venous thromboembolism) risk, as well as the safety, barriers, and utility of VTE prophylaxis. Recent findings In 2019, the Food and Drug Administration (FDA) issued a black box warning concerning the use of tofacitinib among ulcerative colitis (UC) patients with a post hoc analysis revealing that all patients had additional risk factors for VTE. Additionally, although IBD patients experiencing a disease flare often present with hematochezia, these patients are less likely to receive VTE prophylaxis, despite data showing that pharmacologic prophylaxis has not been associated with clinically significant signs of bleeding. Summary Among IBD patients, corticosteroid use has been associated with an increased risk of VTE, whereas anti-TNF therapy does not appear to increase this risk. High-dose
Inflammatory Bowel Disease (G Lichtenstein, Section Editor) tofacitinib has also been shown to increase the likelihood of VTE in patients with additional risk factors. In order to prevent future VTE events, pharmacologic thromboprophylaxis should be emphasized, particularly in hospitalized IBD patients, with recent data suggesting that a select population at risk may benefit from continued prophylaxis.
Introduction Inflammatory bowel disease (IBD), which is comprised of ulcerative colitis (UC) and Crohn’s disease (CD), is a chronic disorder of the gastrointestinal tract characterized by periods of relapse and remission [1, 2]. Patients with IBD are known to have an increased risk of venous thromboembolism (VTE), with factors such as disease activity, surgery, and hospitalization leading to an increase in this risk. Additionally, recent concerns about
the increased VTE risk associated with tofacitinib have shed light on the fa
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