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Inflammatory Bowel Disease Therapy and Venous Thromboembolism

  • Inflammatory Bowel Disease (G Lichtenstein, Section Editor)
  • Published:
Current Treatment Options in Gastroenterology Aims and scope Submit manuscript

Abstract

Purpose of review

To explore the relationship between IBD (inflammatory bowel diseases) therapy and VTE (venous thromboembolism) risk, as well as the safety, barriers, and utility of VTE prophylaxis.

Recent findings

In 2019, the Food and Drug Administration (FDA) issued a black box warning concerning the use of tofacitinib among ulcerative colitis (UC) patients with a post hoc analysis revealing that all patients had additional risk factors for VTE. Additionally, although IBD patients experiencing a disease flare often present with hematochezia, these patients are less likely to receive VTE prophylaxis, despite data showing that pharmacologic prophylaxis has not been associated with clinically significant signs of bleeding.

Summary

Among IBD patients, corticosteroid use has been associated with an increased risk of VTE, whereas anti-TNF therapy does not appear to increase this risk. High-dose tofacitinib has also been shown to increase the likelihood of VTE in patients with additional risk factors. In order to prevent future VTE events, pharmacologic thromboprophylaxis should be emphasized, particularly in hospitalized IBD patients, with recent data suggesting that a select population at risk may benefit from continued prophylaxis.

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Abbreviations

CD:

Crohn’s disease

CI:

Confidence interval

DVT:

Deep venous thrombosis

FDA:

Food and Drug Administration

HR:

Hazard ratio

IRR:

Incidence rate ratio

IBD:

Inflammatory bowel diseases

OR:

Odds ratio

pRBC:

Packed red blood cells

PE:

Pulmonary embolism

RA:

Rheumatoid arthritis

TNF:

Tumor necrosis factor

UC:

Ulcerative colitis

VTE:

Venous thromboembolism

5-ASA:

Aminosalicylates

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Authors and Affiliations

  1. Gastroenterology Department, CHU de Lille – Hôpital Claude Huriez, Université de Lille, Rue Michel Polonovski, 59037, Lille, France

    Thomas Lambin MD

  2. The Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Thomas Lambin MD & Jean-Frédéric Colombel MD

  3. Department of Medicine, New York-Presbyterian Columbia University Medical Center, New York, NY, USA

    Adam S. Faye MD

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Contributions

Review concept and design: TL, ASF

Drafting of the manuscript: TL, ASF

Critical revision of the manuscript for important intellectual content: TL, ASF, JFC

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Correspondence to Thomas Lambin MD.

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Conflict of interest

Thomas Lambin reports receiving grant support from Digest Science Foundation (Lille, France), receiving travel accommodation from Adacyte therapeutics. Adam S Faye reports receiving grant support from NIH: T32DK083256. Jean-Frédéric Colombel reports receiving research grants from AbbVie, Janssen Pharmaceuticals and Takeda; receiving payment for lectures from AbbVie, Amgen, Allergan, Inc. Ferring Pharmaceuticals, Shire, and Takeda; receiving consulting fees from AbbVie, Amgen, Arena Pharmaceuticals, Boehringer Ingelheim, Celgene Corporation, Celltrion, Eli Lilly, Enterome, Ferring Pharmaceuticals, Genentech, Janssen Pharmaceuticals, Landos, Ipsen, Medimmune, Merck, Novartis, O Mass, Pfizer, SERENE CD, Shire, Takeda, Tigenix, Viela bio; and hold stock options in Intestinal Biotech Development and Genfit.

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Lambin, T., Faye, A.S. & Colombel, JF. Inflammatory Bowel Disease Therapy and Venous Thromboembolism. Curr Treat Options Gastro 18, 462–475 (2020). https://doi.org/10.1007/s11938-020-00304-z

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