Incidence of thromboembolism in inflammatory bowel disease: Results from a population-based inception cohort

• Published in: Zeitschrift für Gastroenterologie
• Main Authors: Vegh, Z, Golovics, P, Kurti, Z, Lovasz, B, Szita, I, Balogh, M, Pandur, T, Lakatos, L, Lakatos, P
• Format: Conference Proceeding
• Language: English; German
• Published: 13.05.2014
• ISSN: 0044-2771; 1439-7803
• DOI: 10.1055/s-0034-1376133

Background: Patients with Inflammatory Bowel Disease (IBD) were reported to have an increased risk for venous thromboembolism (VTE), particularly when hospitalized. The estimated risk varies considerably among studies, primarily due to differences in cohort type and methodology. The aim of the present study was to analyze the incidence and risk factors of VTE in a population based inception cohort in the Veszprem province database between 1977 and 2012. Patients and Methods: A total of 1708 incepted IBD patients were included (male/female: 879/829CD: 648, age at onset: 29, IQR: 22 – 39 UC: 1060, age at onset: 36, IQR: 26 – 50 years). Both in- and outpatient records were collected and comprehensively reviewed and followed-up until the 31st of December 2012 for a total of 21369 patient-years. Results: Twenty-two thromboembolic events (TE) were identified in 19 patients (6 events in 5 CD and 16 in 14 UC patients) – 15 deep vein thrombosis (DVT), 5 pulmonary embolism (PE) and 2 mesenterial thrombosis, 81.2% of the events occurred in patients with active disease. 5 patients had a VTE event also prior to IBD diagnosis. The incidence rate of TE was 1.03 per 1000 patient-years. Incidence was higher in males (1.34 per 1000 patient years, p = 0.03, IRR: 2.94, 95%CI: 1.06 – 8.15) compared to females (0.73 per 1000 patient years). The cumulative probability of TE in IBD after 5-, 10- and 15-years after the diagnosis was 0.7%, 1.2% and 1.5%, similar in both CD and UC. Median age at TE event was 37 (IQR: 29 – 46) years, with 6 and 10 patients below 30 and 40 years-of age at TE. The risk of TE in UC was associated with extensive location (OR: 3.25, 95%CI: 1.13 – 9.35), presence of fulminant episode during the disease course (OR: 4.15, 95%CI: 1.28 – 13.5), smoking (OR: 3.46, 95%CI: 1.14 – 10.5) and need for steroids (OR: 2.97, 95%CI: 0.99 – 8.92). Similarly, in CD all but one patients with TE were smokers. Conclusion: The incidence of TE was lower than previously reported. TE developed during active disease, a quarter of the patients had also prior VTE before the IBD diagnosis. The incidence was higher in males and in UC it was associated with extensive disease, fulminant episodes, corticosteroids-requiring disease and smoking, but not with age at onset.