Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK.
Nottingham Digestive Diseases Centre Biomedical Research Unit, University of Nottingham, Nottingham, UK.
Aliment Pharmacol Ther. 2018 Nov;48(10):1099-1108. doi: 10.1111/apt.15010. Epub 2018 Oct 8.
Inflammatory bowel disease (IBD) increases the risk of venous thromboembolism.
To determine when patients are at high risk of thromboembolic events, including after major surgery, and to guide timing of thromboprophylaxis.
Each IBD patient from Clinical Practice Research Datalink, linked with Hospital Episode Statistics, was matched to up to five non-IBD patients in this cohort study. We examined their risk of thromboembolism in hospital and within 6 weeks after leaving hospital, with or without undergoing major surgery, and while ambulant. Hazard ratios were estimated using Cox regression, with adjustment for age, sex, body mass index, smoking and history of malignancy or thromboembolism.
Overall 23 046 IBD patients had a thromboembolic risk 1.74-times (95% CI = 1.55-1.96) higher than 106 795 non-IBD patients. Among ambulant patients, the thromboembolic risk was raised during acute (hazard ratio = 3.94, 2.79-5.57) or chronic disease activity (3.97, 2.90-5.45) but their absolute risk remained below 5/1000 person-years. The hazard ratio for thromboembolism among in-patients not undergoing major surgery was 1.13 (0.63-2.02), compared to 2.43 (1.20-4.92) among surgical patients, with a near doubling of absolute risk associated with surgery (59.5/1000 person-years, compared with 31.1 without surgery). The absolute risk remained elevated within 6 weeks after leaving hospital (18.6/1000 person-years in IBD patients after surgery).
IBD patients are at an increased risk of venous thromboembolism. Absolute risks are raised during active disease, when in hospital, and after leaving hospital following major surgery.
炎症性肠病（IBD）会增加静脉血栓栓塞的风险。
确定患者发生血栓栓塞事件的高危期，包括在重大手术后，并指导血栓预防的时机。
本队列研究中，从临床实践研究数据库中匹配每个 IBD 患者，与医院发病统计数据相关联。我们检查了他们在医院和出院后 6 周内发生血栓栓塞的风险，无论是否接受重大手术以及是否能走动。使用 Cox 回归估计风险比，并调整年龄、性别、体重指数、吸烟状况以及恶性肿瘤或血栓栓塞史。
总体而言，23046 例 IBD 患者的血栓栓塞风险比 106795 例非 IBD 患者高 1.74 倍（95%CI=1.55-1.96）。在能走动的患者中，急性（风险比=3.94，2.79-5.57）或慢性疾病活动期（3.97，2.90-5.45）时血栓栓塞风险增加，但绝对风险仍低于 5/1000 人年。未接受重大手术的住院患者发生血栓栓塞的风险比为 1.13（0.63-2.02），而手术患者为 2.43（1.20-4.92），手术相关的绝对风险增加近一倍（59.5/1000 人年，而无手术者为 31.1/1000 人年）。出院后 6 周内，绝对风险仍然升高（手术患者出院后 IBD 患者为 18.6/1000 人年）。
IBD 患者发生静脉血栓栓塞的风险增加。在疾病活动期、住院期间和重大手术后出院后，绝对风险增加。
