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Prevention and Treatment of Venous Thromboembolism in Patients with IBD

Guideline Watch |
April 23, 2014

Prevention and Treatment of Venous Thromboembolism in Patients with IBD

  1. Douglas K. Rex, MD

New recommendations address managing VTE specifically in patients with IBD, whose risk for VTE is threefold higher than in the general population.

  1. Douglas K. Rex, MD

Sponsoring Organization: Canadian Association of Gastroenterology

Target Population: Gastroenterologists

Background and Objective

This new evidence-based consensus statement was developed to provide recommendations on the prevention and treatment of venous thromboembolism (VTE) in the specific population of patients with inflammatory bowel disease (IBD).

Key Recommendations (in patients with IBD)

  • Hospitalized patients with moderate-to-severe flares without severe bleeding should receive anticoagulant thromboprophylaxis with low-molecular-weight heparin, heparin, or fondaparinux.

  • Patients hospitalized for indications unrelated to IBD or for IBD with non-severe gastrointestinal bleeding should receive anticoagulant prophylaxis.

  • Hospitalized patients with severe IBD-related bleeding should receive mechanical prophylaxis. Once IBD-related bleeding is no longer severe, substitute anticoagulation for mechanical prophylaxis.

  • Patients should receive anticoagulant prophylaxis during hospitalization for major abdominopelvic or general surgery.

  • Outpatients with IBD flares and no prior VTE do not need prophylaxis.

  • Patients with prior VTE and moderate-to-severe flares should receive anticoagulant prophylaxis unless prior episodes occurred only after major surgery.

  • Pregnant women with IBD should receive anticoagulant prophylaxis after C-section until hospital discharge.

  • Patients with VTE who have coexisting IBD do not need testing for hereditary or acquired hypercoagulable states.

  • Patients who experience their first episode of VTE while in remission should receive indefinite anticoagulation unless there is an unrelated reversible provoking factor (then a minimum of 3 months).

  • Patients who experience their first episode of VTE in the presence of active disease should be anticoagulated until IBD is in remission for 3 months.

  • Recommendations for pediatric patients are similar to those for adults.

  • Patients with symptomatic acute splanchnic vein thrombosis (portal, mesenteric, splenic vein thrombosis) should be treated with principles similar to those with VTE in other sites.

  • Patients with asymptomatic, incidentally detected splanchnic vein thrombosis (on imaging studies) should not be anticoagulated.

Comment

Venous thromboembolism is a common problem in inflammatory bowel disease. These recommendations for management are evidence-based, practical, and rational. Patients with IBD are also at increased risk for arterial thromboembolism, with the potential for devastating consequences. My own approach with arterial thromboembolism has been indefinite anticoagulation, but evidence-based recommendations are needed.

  • Disclosures for Douglas K. Rex, MD at time of publication Consultant / Advisory board Given Imaging; Olympus Corporation America; Exact Sciences; Endo Aid Speaker’s bureau Boston Scientific; Braintree Laboratories; Ferring Pharmaceuticals; Olympus America Grant / Research support CDC; Olympus America; Boston Medical Center Editorial boards World Journal of Gastroenterology; The Journal of Clinical Gastroenterology; Techniques in Gastrointestinal Endoscopy; Gastroenterology & Hepatology; Expert Review of Gastroenterology & Hepatology; Medscape Gastroenterology; World Journal of Gastrointestinal Pharmacology and Therapeutics; Annals of Gastroenterology & Hepatology; World Journal of Gastrointestinal Oncology; Comparative Effectiveness Research; Journal of Anesthesia & Clinical Research; Gastroenterology; World Journal of Gastrointestinal Pathophysiology; Gastroenterology Research and Practice; GI & Hepatology News; Gastroenterology Report; Clinical Epidemiology Reviews; JSM Gastroenterology and Hepatology Leadership positions in professional societies American Society for Gastrointestinal Endoscopy (Councilor); US Multi-Society Task Forces (AGA, ACG, ASGE) (Chair)

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