Copyright
©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
Protective effects of long term antiplatelet and anticoagulant therapy in hospitalized patients with inflammatory bowel disease
Madhav Changela, Sagar Pandey, Janak Bahirwani, Nishit Patel, Maulik Kaneriya, Sanket D Basida, Anish Shah, Rahul Thakur, Krishna Bodrya, Suruchi Jai Kumar Ahuja, Yecheskel Schneider
Madhav Changela, Sagar Pandey, Maulik Kaneriya, Department of Internal Medicine, One Brooklyn Health System/Interfaith Medical Center, Brooklyn, NY 11213, United States
Janak Bahirwani, Nishit Patel, Yecheskel Schneider, Department of Gastroenterology, St. Luke's University Health Network, Bethlehem, PA 18015, United States
Sanket D Basida, Department of Internal Medicine, University of Missouri, Columbia, MO 65212, United States
Anish Shah, Department of Internal Medicine, Bronxcare Health System, Bronx, NY 10457, United States
Rahul Thakur, Department of Internal Medicine, Albert Einstein College of Medicine/Jacobi Medical Center, Bronx, NY 10461, United States
Krishna Bodrya, Department of Internal Medicine, Lehigh Valley Health Network, Easton, PA 18045, United States
Suruchi Jai Kumar Ahuja, Department of Data Sciences, Sarepta Therapeutics, Cambridge, MA 02124, United States
Author contributions: Changela M, Pandey S, Bahirwani J, Patel N contributed to conception and design; Changela M, Pandey S, Bahirwani J, Patel N, Kaneriya M, Basida SD, Shah A, Jai Kumar Ahuja S, and Thakur R contributed to provision, collection, assembly of data, and administrative support; Changela M, Pandey S, Bahirwani J, Patel N, Kaneriya M, Basida SD, and Schneider Y contributed to the review of the literature and drafting the manuscript; Changela M, Bahirwani J, and Schneider Y contributed to revision of key components of the manuscript and final approval of manuscript; Changela M, Pandey S, Bahirwani J, Patel N, Kaneriya M, Basida SD, Shah A, Thakur R, Jai Kumar Ahuja S, and Schneider Y are accountable for all aspects of the work.
Institutional review board statement: This study, utilizing the National Inpatient Sample Database, is exempt from full Institutional Review Board review as it involves secondary analysis of de-identified data collected for administrative purposes. The exemption is granted by federal regulations governing research involving publicly available data and poses minimal risk to subjects, maintaining their anonymity. No identifiable information was used, ensuring strict confidentiality. This exemption aligns with ethical standards and guidelines.
Informed consent statement: As patient data was de-identified, informed consent was not required before proceeding with the study.
Conflict-of-interest statement: The authors have no financial relationships or conflicts of interest to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Madhav Changela, MD, Doctor, Department of Internal Medicine, One Brooklyn Health System/Interfaith Medical Center, 1545 Atlantic Av, Brooklyn, NY 11213, United States.
changelamadhav@gmail.com
Received: April 12, 2024
Revised: August 25, 2024
Accepted: September 19, 2024
Published online: November 5, 2024
Processing time: 195 Days and 7.3 Hours
BACKGROUND
Inflammatory bowel disease (IBD), with its rising prevalence rates is associated with an increased risk of cardiovascular and thromboembolic events. Antiplatelets and/or anticoagulants agents are often prescribed but the literature on the impact of long-term anticoagulation and/or antiplatelet use among patients hospitalized with IBD is scarce. The aim of this study is to assess the outcomes of patients hospitalized with IBD on antiplatelet and/or anticoagulant agents.
AIM
To investigate the effects of long-term use of antiplatelets/anticoagulants on clinical outcomes in patients hospitalized with IBD.
METHODS
We conducted a retrospective cohort study using the Nationwide Inpatient Sample database, including all adult IBD patients hospitalized in the United States from 2016 to 2019. Patient cohorts were stratified based on antiplatelet/anticoagulant therapy status. Multivariate regression analysis was done to assess outcomes, adjusting for potential confounders. The primary outcome was mortality, whereas length of stay (LOS), total parenteral nutrition, acute kidney injury, sepsis, shock, gastrointestinal bleeding, need for colonoscopy/sigmoidoscopy, abdominal surgery and total hospitalization charges were secondary outcomes.
RESULTS
Among 374744 hospitalized IBD patients, antiplatelet or anticoagulant therapy alone was associated with significantly lower in-hospital mortality and reduced healthcare utilization, including shorter LOS and decreased hospitalization costs. Combined therapy was associated with a protective effect on mortality, but did not reach statistical significance. Notably, therapy did not exacerbate disease severity or complications, although higher odds of gastrointestinal bleeding were observed.
CONCLUSION
Our study highlights the potential benefits of long-term anticoagulation/antiplatelet therapy in hospitalized IBD patients, with improved mortality outcomes and healthcare utilization. While concerns regarding gastrointestinal bleeding exist, the overall safety profile suggests a role for these agents in mitigating thromboembolic risks without exacerbating disease severity. Further research is needed to look at optimal treatment strategies and addressing limitations to guide clinical decision-making in this population.
Core Tip: In this retrospective study, hospitalized inflammatory bowel disease (IBD) patients on long-term antiplatelet or anticoagulant therapy demonstrated benefits in terms of inpatient mortality, length of stay, and total hospitalization charges compared to those not on such therapy. While the use of anticoagulation alone or in combination with antiplatelet agents was linked to higher odds of lower gastrointestinal bleeding, there was no significant difference in the development of acute kidney injury, sepsis, or the use of total parenteral nutrition. Further research is needed to optimize treatment strategies and inform clinical decision-making in the IBD population.
