Venous thromboembolism and underutilisation of anticoagulant thromboprophylaxis in hospitalised patients with inflammatory bowel disease.

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Venous thromboembolism and underutilisation of anticoagulant thromboprophylaxis in hospitalised patients with inflammatory bowel disease.

Intern Med J. 2014 Jun 3;

Authors: Dwyer JP, Javed A, Hair CS, Moore GT

Abstract
BACKGROUND: Venous thromboembolism (VTE) is a well-recognised extra-intestinal manifestation of inflammatory bowel disease. Despite the widespread support for anticoagulant prophylaxis in hospitalised IBD patients, the utilisation and efficacy in clinical practice is unknown.
AIMS: The aim of this study was to assess the prevalence and clinical features of VTE among hospitalised IBD patients and ascertain whether appropriate thromboprophylaxis had been administered.
METHODS: All patients with a discharge diagnosis of Crohn's disease (CD) or ulcerative colitis (UC) and VTE were retrospectively identified using ICD-10 codes from medical records at our institution from July 1998 to December 2009. Medical records were then reviewed for clinical history and utilisation of thromboprophylaxis. Statistical analysis was performed by Mann-Whitney test and either χ(2) tests or Fisher's exact tests.
RESULTS: Twenty-nine of 3,758 (0.8%) IBD admissions suffered VTE, 13 preadmission and 16 during admission. Of these 29 admissions (in 25 patients), 24% required ICU and 10% died. Of the 16 venous thrombotic events that occurred during an admission, 8 (50%) did not receive anticoagulant thromboprophylaxis and eight (50%) occurred despite thromboprophylaxis. Most thromboembolism despite prophylaxis occurred post intestinal resection (n=5, 63%).
CONCLUSION: Thromboprophylaxis is underutilised in half of IBD patients suffering venous thromboembolism. Prescription of thromboprophylaxis for all hospitalised IBD patients, including dual pharmacological and mechanical prophylaxis in postoperative patients, may lead to a reduction in this preventable complication of IBD.

PMID: 24893756 [PubMed - as supplied by publisher]

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