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World J Gastroenterol. Mar 28, 2014; 20(12): 3173-3179
Published online Mar 28, 2014. doi: 10.3748/wjg.v20.i12.3173
Venous thromboembolism in patients with inflammatory bowel disease: Focus on prevention and treatment
Alfredo Papa, Viviana Gerardi, Manuela Marzo, Carla Felice, Gian Lodovico Rapaccini, Antonio Gasbarrini
Alfredo Papa, Viviana Gerardi, Manuela Marzo, Carla Felice, Gian Lodovico Rapaccini, Antonio Gasbarrini, Internal Medicine and Gastroenterology Unit, Catholic University, 00168 Rome, Italy
Author contributions: Papa A, Gerardi V, Marzo M and Felice C Substantial contributions to the study conception and design, acquisition of data, or analysis and interpretation of data; Papa A, Gerardi V, Rapaccini GL and Gasbarrini A drafting the article or revising it critically for important intellectual content; Papa A, Gerardi V, Marzo M, Felice C, Rapaccini GL and Gasbarrini A final approval of the version to be published.
Correspondence to: Alfredo Papa, MD, Internal Medicine and Gastroenterology Unit, Complesso Integrato Columbus, Catholic University, Via G. Moscati 31-33, 00168 Rome, Italy. apapa@rm.unicatt.it
Telephone: +39-6-3503310 Fax: +39-6-3503310
Received: October 5, 2013
Revised: December 9, 2013
Accepted: January 14, 2014
Published online: March 28, 2014
Processing time: 173 Days and 9.9 Hours
Abstract

Inflammatory bowel disease (IBD) patients have an increased risk of venous thromboembolism (VTE), which represents a significant cause of morbidity and mortality. The most common sites of VTE in IBD patients are the deep veins of the legs and pulmonary system, followed by the portal and mesenteric veins. However, other sites may also be involved, such as the cerebrovascular and retinal veins. The aetiology of VTE is multifactorial, including both inherited and acquired risk factors that, when simultaneously present, multiply the risk to the patient. VTE prevention involves correcting modifiable risk factors, such as disease activity, vitamin deficiency, dehydration and prolonged immobilisation. The role of mechanical and pharmacological prophylaxis against VTE using anticoagulants is also crucial. However, although guidelines recommend thromboprophylaxis for IBD patients, this method is still poorly implemented because of concerns about its safety and a lack of awareness of the magnitude of thrombotic risk in these patients. Further efforts are required to increase the rate of pharmacological prevention of VTE in IBD patients to avoid preventable morbidity and mortality.

Keywords: Inflammatory bowel disease; Venous thromboembolism; Thromboembolic prophylaxis; Anticoagulants; Unfractionated heparin; Low molecular weight heparin

Core tip: Inflammatory bowel diseases (IBD) patients have an increased risk of venous thromboembolism (VTE) that represents a significant cause of morbidity and mortality. The prevention of VTE involves the correction of modifiable risk factors, such as: disease activity, vitamin deficiency, dehydration and prolonged immobilization. Essential is also the role of mechanical and pharmacological prophylaxis. However, thromboprophylaxis in IBD patients, although guideline-recommended is still poorly implemented because of concerns about its safety and, over all, the lack of awareness of the magnitude of thrombotic risk in these patients. Further efforts are required to increase the rate of pharmacological prevention of VTE in IBD so to avoid some preventable morbidity and mortality.