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P674 Clinical features of thrombosis in patients with Crohn’s disease followed at the Clinical Hospital of the University of São Paulo, Brazil

A. Ribas Andrade, L. Leite Barros, M. Azevedo, A. Sipahi, A. Zonetti de Arruda Leite*

University of São Paulo, Medical School, Department of Gastroenterology, São Paulo, Brazil

Background

Thromboembolic events (TE) are associated with high morbidity and mortality immediately after the episode and increasing in likelihood over the next 30 years, especially in the case of pulmonary embolism, and with a long-term effect on the individual’s quality of life. Patients with Crohn’s disease (CD) have a risk of thrombosis 2- to 3-times higher compared with the general population. Although all guidelines recommend prophylaxis treatment for in-patients with active CD, it is still not performed systematically in about 50%. Moreover, to date, there are no guidelines about TE prophylaxis to outpatients with CD, except the Canadian Consensus Statements of Venous Thromboembolism in Inflammatory Bowel Disease,1 which is recommended to outpatients with active CD and prior history of thrombosis. Thus, the aim of this study is to better characterise the clinical features of CD patients with TE and compare it with the current prophylaxis recommendation.

Methods

We analysed 781 electronic charts (from January 2010 to October 2015) of patients followed at our centre and their image exams done after 2011, by electronically searching for words associated with venous thromboembolism. Patients selected in this first search had their chart reviewed to confirm or exclude an episode of TE and were later contacted by telephone to complete any missing information. Data were collected regarding age, sex, ethnicity, smoking status, body mass index, risk factors for TE, as well as disease duration, extension, behaviour, location, activity, and pharmacological treatment, surgeries, and hospitalisation at the time of the event.

Results

In total, 34 patients with TE were identified (4.48%): 11 pulmonary embolism, 10 lower limb, 6 mesenteric, 6 brachiocephalic trunk and upper limbs, and 2 portal vein. Thrombosis was diagnosed in 8 patients (25%) by routine image exams, without any clinical symptoms of thrombosis or history of former TE. In at least 11 patients (40%), TE occurred as an outpatient complication; 8 of them had active CD. In general, the vast majority (88.9%) had active CD at the time of TE. Eighteen patients (64%) had already been submitted to an abdominal surgery. In addition, 27 were taking biologic therapy, suggesting those patients have a more severe disease course. Finally, 4 patients died (10.5%), 3 of them related to TE.

Conclusion

The prevalence of thrombosis in our population (4.48%) was similar to that reported in the literature, but a significant proportion of TE that happened in our patients with CD was not covered by current recommended prophylaxis for TE. New approaches are needed to reduce the risk of TE, especially amongst outpatients with CD with a more severe disease course.

References

[1] Nguyen GC, Bernstein CN, Bitton A, et al. Consensus statements on the risk, prevention, and treatment of venous thromboembolism in inflammatory bowel disease: Canadian association of gastroenterology. Gastroenterol 2014;146(3):835–48.