Susanna Scharrer1, Christian Primas1, Sabine Eichinger2, Sebastian Tonko1,3, Maximilian Kutschera1, Robert Koch4, Andreas Blesl5, Walter Reinisch1, Andreas Mayer6, Thomas Haas7, Thomas Feichtenschlager8, Harry Fuchssteiner9, Pius Steiner10, Othmar Ludwiczek11, Reingard Platzer12, Wolfgang Miehsler13, Wolfgang Tillinger14, Sigrid Apostol15, Alfons Schmid16, Karin Schweiger17, Harald Vogelsang1, Clemens Dejaco1, Harald Herkner18, Gottfried Novacek1. 1. Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria. 2. Department of Internal Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria. 3. Praxis am rhy AG, Kriessern, Switzerland. 4. Department of Internal Medicine I, Medical University of Innsbruck, Innsbruck, Austria. 5. Department of Internal Medicine, Division of Gastroenterology and Hepatology, Medical University of Graz, Graz, Austria. 6. Department of Internal Medicine II, Universitätsklinikum St. Pölten, St. Pölten, Austria. 7. Darmpraxis, Salzburg, Austria. 8. Department of Internal Medicine IV, Hospital Rudolfstiftung, Vienna, Austria. 9. Department of Internal Medicine IV, Hospital Elisabethinen Linz, Linz, Austria. 10. Department of Internal Medicine I, Hospital Wels-Grieskirchen, Wels, Austria. 11. Department of Internal Medicine, Hospital Hall, Tyrol, Austria. 12. Department of Internal Medicine I, Hospital Wiener Neustadt, Wiener Neustadt, Austria. 13. Department of Internal Medicine, Hospital Brothers of St. John of God Salzburg, Salzburg, Austria. 14. Department of Internal Medicine, Franziskus Hospital, Vienna, Austria. 15. Department of Internal Medicine, Hietzing Clinic, Vienna, Austria. 16. Department of Internal Medicine 2, Danube Hospital, Vienna, Austria. 17. Department of Internal Medicine 4, Ottakring Clinic, Vienna, Austria. 18. Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria.
Abstract
BACKGROUND: Little is known about the bleeding risk in patients with inflammatory bowel disease (IBD) and venous thromboembolism (VTE) treated with anticoagulation. Our aim was to elucidate the rate of major bleeding (MB) events in a well-defined cohort of patients with IBD during anticoagulation after VTE. METHODS: This study is a retrospective follow-up analysis of a multicenter cohort study investigating the incidence and recurrence rate of VTE in IBD. Data on MB and IBD- and VTE-related parameters were collected via telephone interview and chart review. The objective of the study was to evaluate the impact of anticoagulation for VTE on the risk of MB by comparing time periods with anticoagulation vs those without anticoagulation. A random-effects Poisson regression model was used. RESULTS: We included 107 patients (52 women, 40 with ulcerative colitis, 64 with Crohn disease, and 3 with unclassified IBD) in the study. The overall observation time was 388 patient-years with and 1445 patient-years without anticoagulation. In total, 23 MB events were registered in 21 patients, among whom 13 MB events occurred without anticoagulation and 10 occurred with anticoagulation. No fatal bleeding during anticoagulation was registered. The incidence rate for MB events was 2.6/100 patient-years during periods exposed to anticoagulation and 0.9/100 patient-years during the unexposed time. Exposure to anticoagulation (adjusted incidence rate ratio, 3.7; 95% confidence interval, 1.5-9.0; P = 0.003) and ulcerative colitis (adjusted incidence rate ratio, 3.5; 95% confidence interval, 1.5-8.1; P = 0.003) were independent risk factors for MB events. CONCLUSION: The risk of major but not fatal bleeding is increased in patients with IBD during anticoagulation. Our findings indicate that this risk may be outweighed by the high VTE recurrence rate in patients with IBD.
BACKGROUND: Little is known about the bleeding risk in patients with inflammatory bowel disease (IBD) and venous thromboembolism (VTE) treated with anticoagulation. Our aim was to elucidate the rate of major bleeding (MB) events in a well-defined cohort of patients with IBD during anticoagulation after VTE. METHODS: This study is a retrospective follow-up analysis of a multicenter cohort study investigating the incidence and recurrence rate of VTE in IBD. Data on MB and IBD- and VTE-related parameters were collected via telephone interview and chart review. The objective of the study was to evaluate the impact of anticoagulation for VTE on the risk of MB by comparing time periods with anticoagulation vs those without anticoagulation. A random-effects Poisson regression model was used. RESULTS: We included 107 patients (52 women, 40 with ulcerative colitis, 64 with Crohn disease, and 3 with unclassified IBD) in the study. The overall observation time was 388 patient-years with and 1445 patient-years without anticoagulation. In total, 23 MB events were registered in 21 patients, among whom 13 MB events occurred without anticoagulation and 10 occurred with anticoagulation. No fatal bleeding during anticoagulation was registered. The incidence rate for MB events was 2.6/100 patient-years during periods exposed to anticoagulation and 0.9/100 patient-years during the unexposed time. Exposure to anticoagulation (adjusted incidence rate ratio, 3.7; 95% confidence interval, 1.5-9.0; P = 0.003) and ulcerative colitis (adjusted incidence rate ratio, 3.5; 95% confidence interval, 1.5-8.1; P = 0.003) were independent risk factors for MB events. CONCLUSION: The risk of major but not fatal bleeding is increased in patients with IBD during anticoagulation. Our findings indicate that this risk may be outweighed by the high VTE recurrence rate in patients with IBD.
Authors: Jan De Laffolie; Antje Ballauff; Stefan Wirth; Carolin Blueml; Frank Risto Rommel; Martin Claßen; Martin Laaß; Thomas Lang; Almuthe Christina Hauer Journal: Front Pediatr Date: 2022-06-03 Impact factor: 3.569