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Inflammatory bowel diseaseassociated thromboembolism: A systematic review of outcomes with anticoagulation versus catheterdirected thrombolysis

Tabibian, James H. MD1,*; Streiff, Michael B. MD2

Inflammatory Bowel Diseases:
doi: 10.1002/ibd.21307
Clinical Reviews
Abstract

Background:: Thromboembolism (TE) is a common extraintestinal complication of inflammatory bowel disease (IBD). Catheter‐directed thrombolysis (CDT) is being increasingly used to treat TE but often evokes fears of hemorrhagic complications (HCs) in patients with IBD. We reviewed clinical outcomes with anticoagulation (AC) and CDT in IBD patients with TE.

Methods:: Published cases of IBD patients with TE were identified by a PubMed search. Cases were divided into two groups based on treatment modality: AC alone or CDT. Pretreatment variables and treatment‐related outcomes were compared between treatment groups.

Results:: Fifty‐two cases of IBD‐associated TE were identified. Thirty‐five cases were treated with AC alone and 17 with CDT. There were no significant differences in pretreatment variables. Patients treated with CDT tended to be more likely to achieve complete or partial symptomatic (P = 0.02) and radiologic resolution (P = 0.06). Gastrointestinal (GI) and non‐GI HCs tended to occur more frequently with CDT, although these differences were not statistically significant (P = 0.44 and 0.15, respectively).

Conclusions:: CDT and AC both appear to be well tolerated by IBD patients with TE. CDT may be used preferentially in patients with life‐threatening TE, while AC may be preferable in patients with less clinically significant TE or patients at higher risk for bleeding. Further prospective studies are warranted to confirm these results and more definitively identify the best therapeutic approach for patients with IBD‐associated TE. (Inflamm Bowel Dis 2011;)

Author Information

1 Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland

2 Division of Hematology, Johns Hopkins Hospital, Baltimore, Maryland

* 924 N. Broadway, Baltimore, MD 21205

Email: jtabibi1@jhmi.edu

Received 10 January 2010; Accepted 3 March 2010

Published online 29 July 2011 in Wiley Online Library (wileyonlinelibrary.com).

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

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