Vascular Complications in Inflammatory Bowel Disease: An Observational Study

Introduction: Increasing evidence has raised an alert about the potential risk of vascular complications in Inflammatory Bowel Disease (IBD). Estimating the magnitude of this risk is imperative to better address IBD patients. The aim of this study was to determine the venous (VTE) and Arterial Thromboembolic Events rates (ATE), as well as the Cardiovascular Events (CVE) and related mortality in IBD inpatients. Methods: Retrospective study including all inpatients from a tertiary hospital with IBD from 1st August 2006 to 31st May 2013 with an episode of VTE/ATE/CVE. The population was characterized using the following variables: IBD (age of diagnosis, type, location/extension/behavior using Montreal classification, activity, medication), vascular complication (diagnosis age, type, location), classical VTE and ATE/CVE risk factors, pharmacological venous thromboembolism prophylaxis and outcome (recurrence, 30-day mortality). Results: We recorded 774 admissions of IBD patients, 28 (3.6%) with thromboembolic episode: 57% male gender; average age 58 ± 17 years (13.8% <40 years); average IBD duration 13 ± 13 years; 57.1%-Ulcerative Colitis (E1-21%, E2-43%, E3-36%), 42.9%-Crohn's disease (L1-70%, L2-10%, L3-20%, B1-25%, B2-42%, B3-33%). Regarding IBD medication: 5-ASA (57%), thiopurines (23%), corticosteroids (15%), Anti-TNFα (12%). Seventeen patients presented with ATE/CVE (10-ischemic stroke, 6-myocardial infarction, 1-peripheral arterial ischaemia); 7 had pulmonary thromboembolism, 3 deep vein thrombosis and 1 superior mesenteric vein thrombosis. At least 39% of these patients had active IBD, mostly with VTE. Six VTE (54%) and 8 ATE/CVE (47%) had other possible concomitant risk factors. One case recurred. No deaths were registered. Conclusion: Both ATE/CVE and VTE are not uncommon in IBD inpatients and several factors appear to be relevant. IBD activity seems to have a close relationship with VTE, in contrast to ATE/CVE, and other IBD characteristics may also influence this risk. A higher effort should be evoked to increase the rate of venous thromboembolic prophylaxis in IBD inpatients.