Review
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World J Gastroenterol. Oct 14, 2014; 20(38): 13863-13878
Published online Oct 14, 2014. doi: 10.3748/wjg.v20.i38.13863
Inflammatory bowel disease and thromboembolism
Petros Zezos, Georgios Kouklakis, Fred Saibil
Petros Zezos, Georgios Kouklakis, Gastrointestinal Endoscopy Unit, University General Hospital of Alexandroupolis, Democritus University of Thrace, 68100 Alexandroupolis, Greece
Petros Zezos, Fred Saibil, Division of Gastroenterology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario M4N 3M5, Canada
Author contributions: Zezos P substantial contributions to conception and design, acquisition of data; Zezos P, Kouklakis G and Saibil F analysis and interpretation of data; Zezos P, Kouklakis G and Saibil F drafting the article or revising it critically for important intellectual content; Zezos P, Kouklakis G and Saibil F final approval of the version to be published.
Correspondence to: Petros Zezos, MD, Division of Gastroenterology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, H52-2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada. zezosp13@hotmail.com
Telephone: +1-416-4804727  Fax: +1-416-4805977
Received: February 25, 2014
Revised: May 24, 2014
Accepted: June 26, 2014
Published online: October 14, 2014
Processing time: 233 Days and 15.7 Hours
Abstract

Patients with inflammatory bowel disease (IBD) have an increased risk of vascular complications. Thromboembolic complications, both venous and arterial, are serious extraintestinal manifestations complicating the course of IBD and can lead to significant morbidity and mortality. Patients with IBD are more prone to thromboembolic complications and IBD per se is a risk factor for thromboembolic disease. Data suggest that thrombosis is a specific feature of IBD that can be involved in both the occurrence of thromboembolic events and the pathogenesis of the disease. The exact etiology for this special association between IBD and thromboembolism is as yet unknown, but it is thought that multiple acquired and inherited factors are interacting and producing the increased tendency for thrombosis in the local intestinal microvasculature, as well as in the systemic circulation. Clinicians’ awareness of the risks, and their ability to promptly diagnose and manage tromboembolic complications are of vital importance. In this review we discuss how thromboembolic disease is related to IBD, specifically focusing on: (1) the epidemiology and clinical features of thromboembolic complications in IBD; (2) the pathophysiology of thrombosis in IBD; and (3) strategies for the prevention and management of thromboembolic complications in IBD patients.

Keywords: Inflammatory bowel disease; Crohn’s disease; Ulcerative colitis; Thrombosis; Thromboembolism; Hypercoagulability; Epidemiology; Endothelial dysfunction; Treatment

Core tip: Thromboembolic complications, both venous and arterial, are serious and challenging complications of inflammatory bowel disease (IBD) and can lead to significant morbidity and mortality. Thrombosis is a specific feature of IBD that can be involved in both the occurrence of thromboembolic events and the pathogenesis of the disease itself. The cause for this association between IBD and thromboembolism is as yet unknown, but multiple acquired and inherited factors have been implicated. Clinicians’ awareness of the risks, and knowledge about the diagnosis and management of thromboembolic complications are of vital importance.