Department of Medicine, University of Ottawa, Ottawa, Canada.
Division of Gastroenterology, The Ottawa Hospital IBD Center, Ottawa, Canada.
Inflamm Bowel Dis. 2020 Oct 23;26(11):1761-1768. doi: 10.1093/ibd/izaa002.
Inflammatory bowel disease (IBD) is associated with a high risk of venous thromboembolism (VTE) during hospitalization. It is unclear if this association persists after discharge. We aimed to assess the incidence of postdischarge VTE in IBD patients and to determine if IBD is associated with increased VTE risk.
We performed a population-based cohort study between 2002 and 2016 using Ontario health administrative data sets. Hospitalized (≥72 hours) adults with IBD were stratified into nonsurgical and surgical cohorts and matched on propensity score to non-IBD controls. Time to postdischarge VTE was assessed by Kaplan-Meier methods, and VTE risk was assessed by Cox proportional hazard models.
A total of 81,900 IBD discharges (62,848 nonsurgical and 19,052 surgical) were matched to non-IBD controls. The cumulative incidence of VTE at 12 months after discharge was 2.3% for nonsurgical IBD patients and 1.6% for surgical IBD patients. The incidence increased in the nonsurgical IBD cohort by 4% per year (incidence rate ratio, 1.04; 95% CI, 1.02-1.05). In our propensity score-matched analysis, the risk of VTE at 1-month postdischarge was greater in nonsurgical IBD patients (hazard ratio [HR], 1.72; 95% CI, 1.51-1.96) and surgical patients with ulcerative colitis (HR, 1.68; 95% CI, 1.16-2.45) but not surgical patients with Crohn's disease. These trends persisted through 12 months.
Nonsurgical IBD patients and surgical patients with ulcerative colitis are 1.7-fold more likely to develop postdischarge VTE than non-IBD patients. These findings support the need for increased vigilance and consideration of thromboprophylaxis in this population.
炎症性肠病（IBD）与住院期间静脉血栓栓塞（VTE）的风险增加相关。但尚不清楚这种相关性在出院后是否仍然存在。我们旨在评估 IBD 患者出院后 VTE 的发生率，并确定 IBD 是否与 VTE 风险增加相关。
我们于 2002 年至 2016 年期间使用安大略省健康管理数据集进行了一项基于人群的队列研究。将住院时间（≥72 小时）的 IBD 成人分为非手术组和手术组，并按倾向评分与非 IBD 对照组匹配。通过 Kaplan-Meier 方法评估出院后 VTE 的时间，通过 Cox 比例风险模型评估 VTE 风险。
共有 81900 例 IBD 出院患者（62848 例非手术和 19052 例手术）与非 IBD 对照组相匹配。非手术 IBD 患者出院后 12 个月的 VTE 累积发生率为 2.3%，手术 IBD 患者为 1.6%。非手术 IBD 队列中 VTE 的发生率每年增加 4%（发病率比，1.04；95%CI，1.02-1.05）。在我们的倾向评分匹配分析中，非手术 IBD 患者在出院后 1 个月时发生 VTE 的风险更高（风险比 [HR]，1.72；95%CI，1.51-1.96），且溃疡性结肠炎手术患者（HR，1.68；95%CI，1.16-2.45），但克罗恩病手术患者则不然。这些趋势持续到 12 个月。
非手术 IBD 患者和溃疡性结肠炎手术患者发生出院后 VTE 的可能性是非 IBD 患者的 1.7 倍。这些发现支持在该人群中增加警惕性并考虑使用血栓预防措施。
