S. Yadukrishna*1, V. Teja1, S. Kedia1, S. Jain1, P. Sahu1, S. Kumar1, G. Makharia1, V. Ahuja1
1All India Institute Of Medical Sciences, New Delhi, India
Inflammatory bowel disease (IBD) is associated with increased risk of thromboembolic (TE) complications. However, the information on exact burden of TE in IBD and its predictors are lacking, especially from developing countries, where IBD is on the rise. The present study aimed to find out the prevalence and predictors of TE in patients with IBD and their prognosis.
A cohort of 3597 patients with IBD (UC n = 2752, CD n = 845) under follow-up from 2004 to 2018 was analysed and this case–control study included 35 IBD patients (ulcerative colitis [UC, n = 25]; Crohn’s disease [CD] n = 10) with history of TE. Details on demographics, extra intestinal manifestations (EIMs), patients status at the time of TE, type and outcome of TE including recurrence, treatment details before and after TE and disease course before and after TE were collected and compared with IBD patients without history of TE in the ratio of 1:4.
The prevalence of TE in patients of IBD was 1% (UC 0.9%, CD 1.2%). Among patients with TE (mean age, 39.6 ± 14 years, 48.6% males), mean duration from disease onset to TE for UC and CD was 35.3 ± 37.4 and 120.2 ± 147.9 months, respectively. More UC patients with TE had severe disease (80% vs. 10%, p < 0.001), pancolitis (79.2% vs. 40%, p = 0.001), other EIMs(44% vs. 22%, p = 0.026), chronic continuous disease course (44% vs. 13%, p < 0.001), steroid dependent disease (60% vs. 13%, p < 0.001),H/o surgery (12% vs. 5%), h/o acute severe colitis (48% vs. 9%, p < 0.001) and mortality related to disease complication (16% vs. 0, p < 0.001) when compared with those without TE. Fifty-two per cent of UC patients with TE were on IV steroids (p < 0.001) and 88% on 5 ASA (p = 0.005) before TE onset. More CD patients with TE had A2 disease (60% vs. 57.5%), terminal ileal ± caecal involvement (55.6% vs. 27.5%), stricturing type of disease (62.5% vs. 30%), moderate to severe form of disease presentation (83.3% vs. 25%, p = 0.004), chronic continuous disease course (50% vs. 10%, p = 0.003), steroid dependent (70% vs. 27.5%, p = 0.012), H/o surgery (20% vs. 7.5%) and mortality related to disease complication (10% vs. 0, p < 0.001). Sixty per cent of CD patients with TE were on oral steroids and 10% on IV steroids before the onset of TE (p = 0.043).
Approximately 1% patients with IBD develop thromboembolism during their disease course. Thromboembolism is a marker of severe disease, and higher disease-related complications including mortality.