Thromboembolic Events in Patients with Inflammatory Bowel Disease: A Comprehensive Overview

Overview

Journal Diseases

Date 2022 Oct 24

PMID 36278572

Authors

Dhir Gala

Taylor Newsome

Nicole Roberson

Soo Min Lee

Marvel Thekkanal

Mili Shah

Vikash Kumar

Praneeth Bandaru

Vijay Gayam

Affiliations

Soon will be listed here.

Abstract

Inflammatory bowel disease (IBD), Crohn's disease and ulcerative colitis are chronic inflammatory disorders of the intestines. The underlying inflammation activates the coagulation cascade leading to an increased risk of developing arterial and venous thromboembolic events such as deep vein thrombosis and pulmonary embolism. Patients with IBD are at a 2-3-fold increased risk of developing thromboembolism. This risk increases in patients with active IBD disease, flare-ups, surgery, steroid treatment, and hospitalization. These complications are associated with significant morbidity and mortality making them important in clinical practice. Clinicians should consider the increased risk of thromboembolic events in patients with IBD and manage them with appropriate prophylaxis based on the risk. In this review, we discuss the literature associated with the pathophysiology of thromboembolism in patients with IBD, summarize the studies describing the various thromboembolic events, and the management of thromboembolism in patients with IBD.

Citing Articles

Spectrum of venous thromboembolism in adult patients with ulcerative colitis in Pakistan: A single center retrospective study.

Karim M, Shaikh H, Ismail F World J Clin Cases. 2025; 13(6):99648.

PMID: 40012826 PMC: 11612674. DOI: 10.12998/wjcc.v13.i6.99648.

A Rare Case of Acute Aortic Occlusion Mimicking Cauda Equina Syndrome in a Patient With Inflammatory Bowel Disease.

Soares A, Ganicho J, Eusebio S, Nascimento P, Ribeiro T Cureus. 2024; 16(11):e73938.

PMID: 39697957 PMC: 11655119. DOI: 10.7759/cureus.73938.

Severe Antiphospholipid Syndrome and Diffuse Glomerulonephritis After Adalimumab Treatment in a Patient With Ulcerative Colitis.

Rivera-Burgos I, Vila L Case Rep Rheumatol. 2024; 2024:8024757.

PMID: 39529874 PMC: 11554406. DOI: 10.1155/2024/8024757.

Controversies in Venous Thromboembolism Risk Assessment in Inflammatory Bowel Disease: A Narrative Review.

Sharma N, Tewatia P, Harvey P, Kumar A Diagnostics (Basel). 2024; 14(19).

PMID: 39410515 PMC: 11476391. DOI: 10.3390/diagnostics14192112.

Recent advancement of novel marine fungi derived secondary metabolite fibrinolytic compound FGFC in biomedical applications: a review.

Jeevithan L, Diao X, Hu J, Elango J, Wu W, Mate Sanchez de Val J Front Cell Infect Microbiol. 2024; 14:1422648.

PMID: 39359937 PMC: 11445226. DOI: 10.3389/fcimb.2024.1422648.

References

Schunemann H, Cushman M, Burnett A, Kahn S, Beyer-Westendorf J, Spencer F . American Society of Hematology 2018 guidelines for management of venous thromboembolism: prophylaxis for hospitalized and nonhospitalized medical patients. Blood Adv. 2018; 2(22):3198-3225. PMC: 6258910. DOI: 10.1182/bloodadvances.2018022954. View

Duricova D, Pedersen N, Elkjaer M, Gamborg M, Munkholm P, Jess T . Overall and cause-specific mortality in Crohn's disease: a meta-analysis of population-based studies. Inflamm Bowel Dis. 2009; 16(2):347-53. DOI: 10.1002/ibd.21007. View

Fumery M, Xiaocang C, Dauchet L, Gower-Rousseau C, Peyrin-Biroulet L, Colombel J . Thromboembolic events and cardiovascular mortality in inflammatory bowel diseases: a meta-analysis of observational studies. J Crohns Colitis. 2013; 8(6):469-79. DOI: 10.1016/j.crohns.2013.09.021. View

Prior A, Strang F, Whorwell P . Internal carotid artery occlusion in association with Crohn's disease. Dig Dis Sci. 1987; 32(9):1047-50. DOI: 10.1007/BF01297197. View

Siegel C, Christensen B, Kornbluth A, Rosh J, Kappelman M, Ungaro R . Guidance for Restarting Inflammatory Bowel Disease Therapy in Patients Who Withheld Immunosuppressant Medications During COVID-19. J Crohns Colitis. 2020; 14(14 Suppl 3):S769-S773. PMC: 7665410. DOI: 10.1093/ecco-jcc/jjaa135. View

Bernstein C, Blanchard J, Houston D, Wajda A . The incidence of deep venous thrombosis and pulmonary embolism among patients with inflammatory bowel disease: a population-based cohort study. Thromb Haemost. 2001; 85(3):430-4. View

Fryer R, Wilson B, Gubler D, Fitzgerald L, Rodgers G . Homocysteine, a risk factor for premature vascular disease and thrombosis, induces tissue factor activity in endothelial cells. Arterioscler Thromb. 1993; 13(9):1327-33. DOI: 10.1161/01.atv.13.9.1327. View

Katsanos A, Kosmidou M, Giannopoulos S, Katsanos K, Tsivgoulis G, Kyritsis A . Cerebral arterial infarction in inflammatory bowel diseases. Eur J Intern Med. 2013; 25(1):37-44. DOI: 10.1016/j.ejim.2013.08.702. View

Melis F, Vandenbrouke J, Buller H, Colly L, Bloemenkamp K . Estimates of risk of venous thrombosis during pregnancy and puerperium are not influenced by diagnostic suspicion and referral basis. Am J Obstet Gynecol. 2004; 191(3):825-9. DOI: 10.1016/j.ajog.2004.02.004. View

10.

Rehman A, Sina C, Gavrilova O, Hasler R, Ott S, Baines J . Nod2 is essential for temporal development of intestinal microbial communities. Gut. 2011; 60(10):1354-62. DOI: 10.1136/gut.2010.216259. View

11.

Bollen L, Vande Casteele N, Peeters M, Bessonov K, Van Steen K, Rutgeerts P . Short-term effect of infliximab is reflected in the clot lysis profile of patients with inflammatory bowel disease: a prospective study. Inflamm Bowel Dis. 2015; 21(3):570-8. DOI: 10.1097/MIB.0000000000000301. View

12.

Lentz S, Sobey C, Piegors D, Bhopatkar M, Faraci F, MALINOW M . Vascular dysfunction in monkeys with diet-induced hyperhomocyst(e)inemia. J Clin Invest. 1996; 98(1):24-9. PMC: 507396. DOI: 10.1172/JCI118771. View

13.

Cosnes J, Gower-Rousseau C, Seksik P, Cortot A . Epidemiology and natural history of inflammatory bowel diseases. Gastroenterology. 2011; 140(6):1785-94. DOI: 10.1053/j.gastro.2011.01.055. View

14.

Ha C, Magowan S, Accortt N, Chen J, Stone C . Risk of arterial thrombotic events in inflammatory bowel disease. Am J Gastroenterol. 2009; 104(6):1445-51. DOI: 10.1038/ajg.2009.81. View

15.

Huerta C, Johansson S, Wallander M, Garcia Rodriguez L . Risk factors and short-term mortality of venous thromboembolism diagnosed in the primary care setting in the United Kingdom. Arch Intern Med. 2007; 167(9):935-43. DOI: 10.1001/archinte.167.9.935. View

16.

Lentz S, Sadler J . Inhibition of thrombomodulin surface expression and protein C activation by the thrombogenic agent homocysteine. J Clin Invest. 1991; 88(6):1906-14. PMC: 295763. DOI: 10.1172/JCI115514. View

17.

Cadwell K, Liu J, Brown S, Miyoshi H, Loh J, Lennerz J . A key role for autophagy and the autophagy gene Atg16l1 in mouse and human intestinal Paneth cells. Nature. 2008; 456(7219):259-63. PMC: 2695978. DOI: 10.1038/nature07416. View

18.

Schurmann G, Bishop A, Facer P, Vecchio M, Lee J, Rampton D . Increased expression of cell adhesion molecule P-selectin in active inflammatory bowel disease. Gut. 1995; 36(3):411-8. PMC: 1382456. DOI: 10.1136/gut.36.3.411. View

19.

Novacek G, Haumer M, Schima W, Muller C, Miehsler W, Polterauer P . Aortic mural thrombi in patients with inflammatory bowel disease: report of two cases and review of the literature. Inflamm Bowel Dis. 2004; 10(4):430-5. DOI: 10.1097/00054725-200407000-00016. View

20.

Harries A, Baird A, Rhodes J . Non-smoking: a feature of ulcerative colitis. Br Med J (Clin Res Ed). 1982; 284(6317):706. PMC: 1496690. DOI: 10.1136/bmj.284.6317.706. View