Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada.
Department of Surgery, McMaster University, Hamilton, Ontario, Canada.
Colorectal Dis. 2020 Jun;22(6):663-678. doi: 10.1111/codi.14853. Epub 2019 Oct 7.
Patients with inflammatory bowel disease (IBD) are at increased risk of postoperative venous thromboembolism (VTE) following major abdominal surgery. The pathogenesis is multifactorial and not fully understood. A combination of pathophysiology, patient and surgical risk factors increase the risk of postoperative VTE in these patients. Despite being at increased risk, IBD patients are not regularly prescribed extended pharmacological thromboprophylaxis following colorectal surgery. Currently, there is a paucity of evidence-based guidelines. Thus, the aim of this review is to evaluate the role of extended pharmacological thromboprophylaxis in IBD patients undergoing colorectal surgery.
A search of Ovid Medline, EMBASE and PubMed databases was performed. A qualitative analysis was performed using 10 clinical questions developed by colorectal surgeons and a thrombosis haematologist. The Newcastle-Ottawa Scale was utilized to assess the quality of evidence.
A total of 1229 studies were identified, 38 of which met the final inclusion criteria (37 retrospective, one case-control). Rates of postoperative VTE ranged between 0.6% and 8.9%. Patient-specific risk factors for postoperative VTE included ulcerative colitis, increased age and obesity. Surgery-specific risk factors for postoperative VTE included open surgery, emergent surgery and ileostomy creation. Patients with IBD were more frequently at increased risk in the included studies for postoperative VTE than patients with colorectal cancer. The risk of bias assessment demonstrated low risk of bias in patient selection and comparability, with variable risk of bias in reported outcomes.
There is a lack of evidence regarding the use of extended pharmacological thromboprophylaxis in patients with IBD following colorectal surgery. As these patients are at heightened risk of postoperative VTE, future study and consideration of the use of extended pharmacological thromboprophylaxis is warranted.
炎症性肠病（IBD）患者在接受大腹部手术后发生静脉血栓栓塞（VTE）的风险增加。其发病机制是多因素的，尚未完全阐明。病理生理学、患者和手术危险因素的综合作用增加了这些患者术后发生 VTE 的风险。尽管风险增加，但 IBD 患者在结直肠手术后并未常规接受延长的药物性血栓预防。目前，缺乏循证指南。因此，本综述的目的是评估在接受结直肠手术的 IBD 患者中延长药物性血栓预防的作用。
对 Ovid Medline、EMBASE 和 PubMed 数据库进行了检索。使用由结直肠外科医生和血栓血液病学家制定的 10 个临床问题进行了定性分析。使用纽卡斯尔-渥太华量表评估证据质量。
共确定了 1229 项研究，其中 38 项符合最终纳入标准（37 项回顾性研究，1 项病例对照研究）。术后 VTE 的发生率在 0.6%至 8.9%之间。术后 VTE 的患者特定危险因素包括溃疡性结肠炎、年龄增加和肥胖。术后 VTE 的手术特定危险因素包括开放性手术、紧急手术和造口术。在纳入的研究中，与结直肠癌患者相比，IBD 患者发生术后 VTE 的风险更高。风险评估显示，在患者选择和可比性方面存在低偏倚风险，在报告结果方面存在可变的偏倚风险。
关于在接受结直肠手术后的 IBD 患者中使用延长的药物性血栓预防，目前证据不足。由于这些患者术后发生 VTE 的风险增加，因此需要进一步研究和考虑使用延长的药物性血栓预防。
