Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK.
Lancet. 2010 Feb 20;375(9715):657-63. doi: 10.1016/S0140-6736(09)61963-2. Epub 2010 Feb 8.
Patients with inflammatory bowel disease who develop deep vein thrombosis or pulmonary embolism often have active disease at the time of thromboembolism. We therefore aimed to quantify the risk of venous thromboembolism prospectively during different activity phases of inflammatory bowel disease.
From the General Practice Research Database, we matched patients with prospectively recorded inflammatory bowel disease from November, 1987, until July, 2001 with up to five controls by age, sex, and general practice. A flare was defined as the period 120 days after a new corticosteroid prescription. We used Cox regression analysis with time-varying covariates to accommodate changes in the state of inflammatory bowel disease, and whether patients were at high risk of venous thromboembolism after hospitalisation.
13 756 patients with inflammatory bowel disease and 71 672 matched controls were included in the analysis, and of these 139 patients and 165 controls developed venous thromboembolism. Overall, patients with inflammatory bowel disease had a higher risk of venous thromboembolism than did controls (hazard ratio 3.4, 95% CI 2.7-4.3; p<0.0001; absolute risk 2.6 per 1000 per person-years). At the time of a flare, however, this increase in risk was much more prominent (8.4, 5.5-12.8; p<0.0001; 9.0 per 1000 person-years). This relative risk at the time of a flare was higher during non-hospitalised periods (15.8, 9.8-25.5; p<0.0001; 6.4 per 1000 person-years) than during hospitalised periods (3.2, 1.7-6.3; p=0.0006; 37.5 per 1000 person-years).
Trials of primary prophylaxis of venous thromboembolism are warranted to find out whether this important complication can be prevented.
National Association for Colitis and Crohn's Disease.
患有炎症性肠病并发生深静脉血栓或肺栓塞的患者在血栓栓塞时通常存在活动期疾病。因此，我们旨在前瞻性地量化炎症性肠病不同活动期的静脉血栓栓塞风险。
从全科医学研究数据库中，我们将 1987 年 11 月至 2001 年 7 月前瞻性记录的炎症性肠病患者与最多 5 名年龄、性别和全科医学相匹配的对照患者进行匹配。炎症发作定义为新皮质类固醇处方后 120 天的时期。我们使用时变协变量的 Cox 回归分析来适应炎症性肠病状态的变化，以及患者在住院后是否存在静脉血栓栓塞的高风险。
纳入分析的 13756 例炎症性肠病患者和 71672 例匹配对照患者中，有 139 例患者和 165 例对照患者发生静脉血栓栓塞。总体而言，炎症性肠病患者的静脉血栓栓塞风险高于对照患者（风险比 3.4，95%CI 2.7-4.3；p<0.0001；绝对风险为每 1000 人年 2.6 例）。然而，在发作时，这种风险的增加更为明显（8.4，5.5-12.8；p<0.0001；每 1000 人年 9.0 例）。在发作时的这种相对风险在非住院期间（15.8，9.8-25.5；p<0.0001；每 1000 人年 6.4 例）高于住院期间（3.2，1.7-6.3；p=0.0006；每 1000 人年 37.5 例）。
需要进行初级预防静脉血栓栓塞的试验，以确定是否可以预防这一重要并发症。
国家结肠炎和克罗恩病协会。
