P695 Does anticoagulation treatment increase the rate of major bleeding complications in patients with IBD and venous thromboembolism?

• Published in: Journal of Crohn's and colitis Vol. 12; no. supplement_1; pp. S462 - S463
• Main Authors: Novacek, G, Tonko, S, Sobala, A, Tilg, H, Petritsch, W, Reinisch, W, Mayer, A, Haas, T, Ludwiczek, O, Feichtenschlager, T, Fuchssteiner, H, Steiner, P, Vogelsang, H, Miehsler, W, Platzer, R, Tillinger, W, Schmid, A, Blaha, B, Herkner, H
• Format: Journal Article
• Language: English
• Published: UK Oxford University Press 16.01.2018
• ISSN: 1873-9946; 1876-4479
• DOI: 10.1093/ecco-jcc/jjx180.822

Abstract Background Patients with inflammatory bowel disease (IBD) are at increased risk of first and recurrent venous thromboembolism (VTE). Anticoagulation (AC) is the standard treatment of VTE, but might lead to bleeding complications. We sought to investigate if the bleeding rate is increased during episodes with AC in patients with IBD and VTE. Methods In a previous study 157 IBD patients with objectively diagnosed VTE were identified. From these patients 107 were included in the analysis. Data were recorded from the medical records and by interviewing the patients via a phone call. The primary end point was the occurrence of a severe bleeding complication, which was defined as a fatal bleeding or a symptomatic bleeding in a critical organ (e.g. intracerebral bleeding) or a bleeding leading to a loss of haemoglobin of ≥20 g l−1or leading to a transfusion of ≥2 red cell packages (RCP). The study is a sequential therapy comparison, in which the bleeding rate in the same patient during episodes under and without AC was compared. Patients contributed episodes with and without AC with variable length. The unit of analysis was each episode. To allow for this longitudinal data structure we used regression models with weighting for the length of each separate episode and based the calculation of 95% confidence intervals and p-values on cluster robust standard errors with patients ID as the identifier. Anticoagulation yes vs. no was the main covariate. For binary outcomes we used logistic models , otherwise we used linear models. To adjust for other clinically predetermined influential variables we used multivariable regression models. Results A total of 195 episodes without AC and 144 episodes under AC were observed. 21 major bleedings occurred. 10 under AC (5 under heparin and 5 under vitamin-K antagonist treatment) (8: transfusion of ≥2 RCP; 2: loss of haemoglobin of ≥ 20 g l-1) and 11 without AC (8: transfusion of ≥2 RCP; 2: loss of haemoglobin of ≥20 g l-1; 1: death) (Table 1). Major bleeding complications did not occur more often in time periods under AC than in time periods without AC using Fisher’s exact test (p = 0.65). This was confirmed by logistic regression (Table 2). Table 1. Number of major bleeding complications in time periods under and without anticoagulation treatment (AC). AC No major bleeding Major bleeding Total No 184 (94.4%) 11 (5.6%) 195 Yes 134 (93.1%) 10 (6.9%) 144 Total 318 (93.8%) 21 (6.2%) 339 Table 2. Logistic regression for major bleeding complications. Major bleeding Odds ratio (95% CI) P Anticoagulation 2.54 (0.66–9.77) 0.176 Age 0.99 (0.96–1.02) 0.663 Sex (female) 0.30 (0.08–1.10) 0.071 Crohn’s disease 2.14 (0.64–7.15 0.217 Conclusions Our data suggest that anticoagulant treatment after VTE does not increase the risk of major bleeding complications in patients with IBD.