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Thrombosis and inflammatory bowel disease: A call for improved awareness and prevention

Zitomersky, Naamah L. MD1; Verhave, Menno MD1; Trenor, Cameron C. III MD2

doi: 10.1002/ibd.21334
Clinical Review Articles

Thrombotic complications in patients with inflammatory bowel disease (IBD) are common and require improved awareness and prevention. In this review the interface between IBD and thrombosis is discussed, with emphasis on risk assessment and data to aid clinical decision making. Thromboembolic complications are 3‐fold more likely in IBD patients than controls and the relative risk exceeds 15 during disease flares. Improved assessment of thrombosis risk for an individual patient includes thorough personal and family history and awareness of prothrombotic medications and lifestyle choices. Patients with the highest risk of thrombosis are those with active colonic disease, personal or strong family history of thrombosis, and those with significant acquired risk factors. Combined risk factors or hospitalization should prompt mechanical thromboprophylaxis. Indications for prophylactic anticoagulation are not defined currently by clinical studies, especially in pediatric patients, although some groups now advocate prophylactic anticoagulation for all hospitalized IBD patients and even some outpatients with disease flares. Thrombosis management requires a multidisciplinary therapeutic approach to balance anticoagulation and bleeding risk. While bleeding may occur with anticoagulation in IBD, data and experience indicate that therapeutic heparin is safe and bleeding manifestations can be managed supportively in most patients. Until prospective trials of prophylactic anticoagulation are published, management of thrombotic risk and prophylaxis in IBD will remain a clinical challenge. (Inflamm Bowel Dis 2011;)

1Division of Gastroenterology, Children's Hospital Boston, Harvard Medical School, Boston, Massachusetts

2Division of Hematology/Oncology, Children's Hospital Boston, Harvard Medical School, Boston, Massachusetts

Reprints: Children's Hospital Boston, 300 Longwood Ave., Boston, MA 02115

Email: naamah.zitomersky@childrens.harvard.edu

Received 22 March 2010; Accepted 29 March 2010

N.L.Z. is supported by the NIH/NIDDK (2 T32 DK007477‐26); C.C.T. is supported by the NIH/NHLBI (K08 HL089509‐01A1).

© Crohn's & Colitis Foundation of America, Inc.
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