住院的急性炎症性肠病发作患者对血栓预防的认识不足与静脉血栓栓塞症发生率低有关。

Unawareness of thromboprophylaxis is associated with low venous thromboembolism occurrence in hospitalized patients with acute inflammatory bowel disease flare.

机构信息

Department of Gastroenterology, Galilee Medical Center, Nahariya, Israel.

Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel.

出版信息

Minerva Med. 2020 Dec;111(6):560-565. doi: 10.23736/S0026-4806.20.06885-8. Epub 2020 Jul 28.

DOI:10.23736/S0026-4806.20.06885-8

PMID:32729705

Abstract

BACKGROUND

Inflammatory bowel disease (IBD) is a set of chronic inflammatory diseases associated with significant morbidity. Generally, IBD patients have twice the risk of venous thromboembolism (VTE) compared to healthy controls. VTE can occur both, during hospital stay or after discharge. We aimed to assess the incidence among IBD patients who were hospitalized for disease exacerbation.

METHODS

In a retrospective cross-sectional analysis all IBD patients who were admitted with disease exacerbation at Galilee Medical Center and Hadassah Medical Organization were included in the study. Excluding criteria was IBD with already known hypercoagulable state.

RESULTS

One-hundred and sixteen patients with 176 admissions due to IBD flare were included in the study. The average age was 38.3±16.3 years. Sixty-six admissions (37.5%) occurred in patients with ulcerative colitis exacerbation and 110 in patients with Crohn's disease exacerbation (62.5%). Thirty-nine patients (22.1%) were smokers. Fifty-four patients (30.7%) and 68 patients (38.6%) were on previous (within 3 months) biological and steroid treatment, respectively. Twelve patients (6.8%) were on prophylactic subcutaneous anticoagulation (enoxaparin) throughout their hospital stay and only 3 patient (1.7%) developed in-hospital clinical VTE episode. The mean hospitalization length was 6.8±7.9 days and among patients who developed VTE episode, the length of stay was significantly higher as compared to patients without VTE episodes (36.7 vs. 6.3 days, P<0.0001). Notably, in-hospital IBD related-surgical procedure was the only risk factor for the development of VTE (Odds Ratio: 36.2; P=0.01).

CONCLUSIONS

In-hospital VTE is rare among IBD patients admitted with exacerbation. Further studies are warranted to assess risk factors for in-hospital VTE development and to assess further the role of prophylactic anticoagulation among IBD patients with bloody diarrhea.

摘要

背景

炎症性肠病（IBD）是一组与显著发病率相关的慢性炎症性疾病。一般来说，与健康对照组相比，IBD 患者发生静脉血栓栓塞症（VTE）的风险增加了一倍。VTE 既可以在住院期间发生，也可以在出院后发生。我们旨在评估因疾病恶化而住院的 IBD 患者中的发病率。

方法

在一项回顾性横断面分析中，纳入了在加利利医疗中心和哈达萨医疗组织因疾病恶化而住院的所有 IBD 患者。排除标准是 IBD 已经存在已知的高凝状态。

结果

研究纳入了 116 例因 IBD 发作而住院的 176 例患者。平均年龄为 38.3±16.3 岁。66 例（37.5%）住院是溃疡性结肠炎恶化引起的，110 例（62.5%）是克罗恩病恶化引起的。39 例（22.1%）是吸烟者。54 例（30.7%）和 68 例（38.6%）分别在之前（3 个月内）接受过生物制剂和类固醇治疗。12 例（6.8%）在整个住院期间接受预防性皮下抗凝（依诺肝素）治疗，仅有 3 例（1.7%）发生院内临床 VTE 事件。平均住院时间为 6.8±7.9 天，与未发生 VTE 事件的患者相比，发生 VTE 事件的患者住院时间明显更长（36.7 天 vs. 6.3 天，P<0.0001）。值得注意的是，住院期间与 IBD 相关的手术是发生 VTE 的唯一危险因素（优势比：36.2；P=0.01）。