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Aldiabat M, Alhuneafat L, Al Ta'ani O, Altarawneh S, Aleyadeh W, Almuzamil T, Butt A, Alahmad M, Madi MY, Alsabbagh K, Ayoub M, Kilani Y, Alsakarneh S, Jaber F, Alhamdani A. Inflammatory bowel disease and pulmonary embolism: a nationwide perspective. Eur J Gastroenterol Hepatol 2024:00042737-990000000-00405. [PMID: 39292971 DOI: 10.1097/meg.0000000000002851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/20/2024]
Abstract
OBJECTIVE To examine the characteristics and outcomes of patients with inflammatory bowel disease (IBD) hospitalized with pulmonary embolism (PE). METHODS This cross-sectional observational study analyzed data from the 2016 to 2019 National Inpatient Sample to investigate hospitalizations for PE in the USA, stratified by the presence or absence of IBD. Adult patients were selected using the International Classification of Diseases, Tenth Revision codes for PE, Crohn's disease, and ulcerative colitis. Data on patient demographics, comorbidities, and hospital characteristics were collected. Statistical analysis included univariable and multivariable logistic regression using Stata/BE 17.0, focusing on in-hospital mortality and complications in PE patients with and without IBD. Adjusted odds ratios (aOR) and their corresponding 95% confidence intervals (CI) were calculated when appropriate. RESULTS PE/IBD group was younger (mean age 58.3 vs. 62.7 years; P < 0.001), had a higher proportion of white patients (81.2% vs. 70.9%; P < 0.001), and had a greater prevalence of chronic liver disease (7.54% vs. 6.02%; P = 0.002) when compared to PE/non-IBD patients. The PE/IBD group had lower prevalence rates of coronary artery disease, congestive heart failure, obesity, chronic obstructive pulmonary disease, hypertension, and diabetes. Regarding primary outcomes, there was no significant difference in in-hospital mortality between the two groups (aOR, 0.92; 95% CI, 0.77-1.09; P = 0.355). However, the IBD/PE group had a higher risk of acute kidney injury, sepsis, septic shock, cardiac arrhythmias, and deep vein thrombosis. As for secondary outcomes, PE/IBD patients had more extended hospital stays and higher healthcare costs compared with PE/non-IBD patients. CONCLUSION Hospitalized PE patients with IBD differ demographically and have a different comorbidity profile compared to those without IBD. PE/IBD patients demonstrate greater use of healthcare resources and elevated risk of hospitalization adverse events than PE/non-IBD patients, highlighting the necessity for individualized management approaches in this population.
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Affiliation(s)
- Mohammad Aldiabat
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA
| | - Laith Alhuneafat
- Department of Cardiovascular Disease, University of Minnesota, Minneapolis, MN
| | - Omar Al Ta'ani
- Department of Medicine, Allegheny Health Network, Pittsburgh
| | - Saba Altarawneh
- Division of Gastroenterology, Department of Medicine,The Wright Center for Graduate Medical Education, Scranton, PA
| | - Wesam Aleyadeh
- Department of Medicine, Akron General Hospital, Akron, Ohio
| | | | - Ali Butt
- Department of Medicine, Allegheny Health Network, Pittsburgh
| | - Majd Alahmad
- Department of Medicine, University of Missouri-Columbia, Columbia, Missouri
| | - Mahmoud Y Madi
- Division of Gastroenterology, Department of Medicine, SSM Health Saint Louis University Hospital, St. Louis, Missouri
| | | | - Malek Ayoub
- Department of Medicine, Washington University in St. Louis, St. Louis, Missouri
| | - Yassine Kilani
- Department of Medicine, Lincoln Medical Center/Weill Cornell Medicine, Bronx, New York
| | - Saqr Alsakarneh
- Department of Medicine, University of Missouri Kansas City, Kansas City, Missouri and
| | - Fouad Jaber
- Department of Medicine, University of Missouri Kansas City, Kansas City, Missouri and
| | - Adee Alhamdani
- Division of Cardiology, Department of Medicine, Marshall University, Huntington, West Virginia, USA
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2
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Jevnikar M, Poenou G, Montani D, Bertoletti L. Venous thromboembolism in sarcoidosis: Mere comorbidity or catalyst for disease evolution? Respir Med Res 2024; 85:101062. [PMID: 38134468 DOI: 10.1016/j.resmer.2023.101062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 10/29/2023] [Indexed: 12/24/2023]
Affiliation(s)
- Mitja Jevnikar
- Université Paris-Saclay, Faculty of Medicine, Le Kremlin-Bicêtre, France; INSERM UMR_S 999 «Pulmonary Hypertension: Pathophysiology and Novel Therapies», Hôpital Marie Lannelongue, Le Plessis Robinson, France; AP-HP, Department of Respiratory and Intensive Care Medicine, Pulmonary Hypertension National Referral Centre, Hôpital Bicêtre, DMU 5 Thorinno, Le Kremlin-Bicêtre, France.
| | - Géraldine Poenou
- CHU de St-Etienne, Service de Médecine Vasculaire et Thérapeutique, Saint-Etienne, France; INSERM, UMR1059, Equipe Dysfonction Vasculaire et Hémostase, Université Jean-Monnet, F-42055, Saint-Etienne, France
| | - David Montani
- Université Paris-Saclay, Faculty of Medicine, Le Kremlin-Bicêtre, France; INSERM UMR_S 999 «Pulmonary Hypertension: Pathophysiology and Novel Therapies», Hôpital Marie Lannelongue, Le Plessis Robinson, France; AP-HP, Department of Respiratory and Intensive Care Medicine, Pulmonary Hypertension National Referral Centre, Hôpital Bicêtre, DMU 5 Thorinno, Le Kremlin-Bicêtre, France
| | - Laurent Bertoletti
- CHU de St-Etienne, Service de Médecine Vasculaire et Thérapeutique, Saint-Etienne, France; INSERM, UMR1059, Equipe Dysfonction Vasculaire et Hémostase, Université Jean-Monnet, F-42055, Saint-Etienne, France; INSERM, CIC-1408, CHU Saint-Etienne, F-42055, Saint-Etienne, France
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3
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Oyama Y, Koiwa S, Maruyama T, Kozuka A, Hiramori S, Kobayashi T, Yahikozawa K, Miyagi T, Sakai T, Otagiri K, Kitabayashi H. Abdominal aortic mural thrombus in association with active ulcerative colitis. J Cardiol Cases 2024; 29:170-173. [PMID: 38646077 PMCID: PMC11031649 DOI: 10.1016/j.jccase.2023.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 11/22/2023] [Accepted: 12/24/2023] [Indexed: 04/23/2024] Open
Abstract
Aortic mural thrombus (AMT) in the absence of aneurysm or atherosclerosis is a rare clinical finding and an uncommon cause of peripheral arterial embolization. AMT in a normal artery is usually attributed to systemic hypercoagulability. We describe a case of subacute lower limb ischemia due to AMT associated with active ulcerative colitis (UC). A 46-year-old man with active UC was referred to our hospital for the evaluation and treatment of left leg pain. Ultrasound and contrast computed tomography showed occlusion of the left popliteal artery, and an AMT in the abdominal aorta between the inferior mesenteric artery and the aortic bifurcation. We started anticoagulant therapy, intravenous infliximab, and cytapheresis. Four weeks after initiating anticoagulation therapy, we were able to successfully treat the AMT with anticoagulation therapy without surgical thrombectomy. The inflammatory status of ulcerative colitis was also under control, and AMT had not recurred at 1 year after treatment. Invasive therapies are often selected to treat AMT. However, if a patient's hypercoagulable state is controlled, AMT can safely be treated with anticoagulation therapy alone without recurrence. Learning objective Aortic mural thrombus (AMT) in the absence of aneurysm or atherosclerosis is a rare clinical finding and an uncommon cause of peripheral arterial embolization. AMT in a normal artery is usually attributed to systemic hypercoagulability. We describe a case of subacute lower limb ischemia due to AMT associated with active ulcerative colitis. We controlled the ulcerative colitis condition and successfully treated the AMT with anticoagulation therapy alone.
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Affiliation(s)
- Yushi Oyama
- Department of Cardiology, Ina Central Hospital, Nagano, Japan
| | - Satoshi Koiwa
- Department of Cardiovascular Medicine, Minaminagano Medical Center, Shinonoi General Hospital, Nagano, Japan
| | - Takuya Maruyama
- Department of Cardiovascular Medicine, Minaminagano Medical Center, Shinonoi General Hospital, Nagano, Japan
| | - Ayako Kozuka
- Department of Cardiovascular Medicine, Minaminagano Medical Center, Shinonoi General Hospital, Nagano, Japan
| | - Seiichi Hiramori
- Department of Cardiovascular Medicine, Minaminagano Medical Center, Shinonoi General Hospital, Nagano, Japan
| | - Takahiro Kobayashi
- Department of Cardiovascular Medicine, Minaminagano Medical Center, Shinonoi General Hospital, Nagano, Japan
| | - Kumiko Yahikozawa
- Department of Cardiovascular Medicine, Minaminagano Medical Center, Shinonoi General Hospital, Nagano, Japan
| | - Takuya Miyagi
- Department of Cardiology, Ina Central Hospital, Nagano, Japan
| | - Takahiro Sakai
- Department of Cardiology, Ina Central Hospital, Nagano, Japan
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Rohani P, Taraghikhah N, Nasehi MM, Alimadadi H, Assadzadeh Aghdaei H. Cerebrovascular Events in Pediatric Inflammatory Bowel Disease: A Review of Published Cases. Pediatr Gastroenterol Hepatol Nutr 2022; 25:180-193. [PMID: 35611378 PMCID: PMC9110847 DOI: 10.5223/pghn.2022.25.3.180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 02/27/2022] [Accepted: 03/07/2022] [Indexed: 11/14/2022] Open
Abstract
Pediatric inflammatory bowel disease (PIBD) is a multisystem disorder characterized by intestinal and extraintestinal manifestations and complications. Cerebrovascular events (CVE) are rare extraintestinal complications in patients with PIBD. Statistics show that 3.3% patients with PIBD and 1.3-6.4% adult patients with inflammatory bowel disease (IBD) experience CVE during the course of the disease. Therefore, this study aimed to review the records of children with IBD who developed CVE during the course of the disease. We retrospectively reviewed 62 cases of PIBD complicated by CVE. The mean patient age at the time of thrombotic events was 12.48±4.13 years. The incidence of ulcerative colitis was significantly higher than that of Crohn's disease (43 [70.5%] vs. 13 [21.3%] patients). Most patients (87.93%) were in the active phase of IBD at the time of CVE. The mean time interval between the onset of IBD and CVE was 20.84 weeks. Overall, 11 (26.83%) patients showed neurological symptoms of CVE at disease onset. The most frequent symptom on admission was persistent and severe headaches (67.85%). The most common site of cerebral venous thrombosis was the transverse sinuses (n=23, 53.48%). The right middle cerebral artery (n=3, 33.34%) was the predominant site of cerebral arterial infarction. Overall, 41 (69.49%) patients who were mostly administered unfractionated heparin or low-molecular-weight heparin (56.09%) recovered completely. Patients with IBD are at a risk of thromboembolism. CVE may be the most common type of thromboembolism. Based on these findings, the most common risk factor for CVE is IBD flares. In patients with CVE, anticoagulant therapy with heparin, followed by warfarin, is necessary.
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Affiliation(s)
- Pejman Rohani
- Pediatric Gastroenterology and Hepatology Research Center, Children's Medical Center, Pediatrics Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran
| | - Nazanin Taraghikhah
- Research Institute for Gastroenterology and Liver Disease, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Mehdi Nasehi
- Pediatric Neurology Research Center, Shahid Beheshti University of Medical Sciences, Research Institute for Children Health, Tehran, Iran
| | - Hosein Alimadadi
- Pediatric Gastroenterology and Hepatology Research Center, Children's Medical Center, Pediatrics Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamid Assadzadeh Aghdaei
- Research Institute for Gastroenterology and Liver Disease, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Setyawan J, Mu F, Zichlin ML, Billmyer E, Downes N, Yang H, Azimi N, Strand V, Yarur A. Risk of Thromboembolic Events and Associated Healthcare Costs in Patients with Inflammatory Bowel Disease. Adv Ther 2022; 39:738-753. [PMID: 34877631 PMCID: PMC8799565 DOI: 10.1007/s12325-021-01973-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 10/22/2021] [Indexed: 12/13/2022]
Abstract
Introduction Inflammatory bowel disease (IBD) is associated with greater risk of thromboembolic events (TEs) due to the link between systemic inflammation and hypercoagulability. This study assessed the rates of TEs among patients with IBD versus patients without immune-mediated disease (IMD) and the cost of TEs among patients with IBD in the United States. Methods This study used the IBM MarketScan® Commercial and Medicare Supplemental Databases (2014–2018). To assess the incremental rates of TEs (deep vein thrombosis [DVT], pulmonary embolism [PE], ischemic stroke [IS], myocardial infarction [MI]), patients with IBD were matched to patients without IMD. Unadjusted and adjusted incidence rate ratios (IRRs) of TEs were used to compare cohorts. To assess the cost of TEs, patients with IBD with TEs were matched to patients with IBD without TEs. Costs were assessed 30 days and 1 year post index date. Results There were 34,687 matched pairs included in the rates of TE analyses. Compared to patients without IMD, patients with IBD had greater rates of DVT (adjusted IRR [95% confidence interval] 2.44 [2.00, 2.99]; p < 0.01) and PE (1.90 [1.42, 2.54]; p < 0.01). Increased rates were not observed for IS and MI. There were 1885 matched pairs included in the cost of TE analyses. Patients with IBD with TEs incurred greater healthcare costs over 30 days and 1 year versus patients without TEs (adjusted total cost difference: 30 days $20,784; 1 year $44,630; p < 0.01 for both). Conclusions Patients with IBD experienced greater rates of DVT and PE compared to patients without IMD; this elevated risk was associated with a substantial economic burden. Supplementary Information The online version contains supplementary material available at 10.1007/s12325-021-01973-7.
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Mazza S, Soro S, Verga MC, Elvo B, Ferretti F, Cereatti F, Drago A, Grassia R. Liver-side of inflammatory bowel diseases: Hepatobiliary and drug-induced disorders. World J Hepatol 2021; 13:1828-1849. [PMID: 35069993 PMCID: PMC8727201 DOI: 10.4254/wjh.v13.i12.1828] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 07/16/2021] [Accepted: 11/15/2021] [Indexed: 02/06/2023] Open
Abstract
Hepatobiliary disorders are among the most common extraintestinal manifestations in inflammatory bowel diseases (IBD), both in Crohn’s disease and ulcerative colitis (UC), and therefore represent a diagnostic challenge. Immune-mediated conditions include primary sclerosing cholangitis (PSC) as the main form, variant forms of PSC (namely small-duct PSC, PSC-autoimmune hepatitis overlap syndrome and IgG4-related sclerosing cholangitis) and granulomatous hepatitis. PSC is by far the most common, presenting in up to 8% of IBD patients, more frequently in UC. Several genetic foci have been identified, but environmental factors are preponderant on disease pathogenesis. The course of the two diseases is typically independent. PSC diagnosis is based mostly on typical radiological findings and exclusion of secondary cholangiopathies. Risk of cholangiocarcinoma is significantly increased in PSC, as well as the risk of colorectal cancer in patients with PSC and IBD-related colitis. No disease-modifying drugs are approved to date. Thus, PSC management is directed against symptoms and complications and includes medical therapies for pruritus, endoscopic treatment of biliary stenosis and liver transplant for end-stage liver disease. Other non-immune-mediated hepatobiliary disorders are gallstone disease, whose incidence is higher in IBD and reported in up to one third of IBD patients, non-alcoholic fatty liver disease, pyogenic liver abscess and portal vein thrombosis. Drug-induced liver injury (DILI) is an important issue in IBD, since most IBD therapies may cause liver toxicity; however, the incidence of serious adverse events is low. Thiopurines and methotrexate are the most associated with DILI, while the risk related to anti-tumor necrosis factor-α and anti-integrins is low. Data on hepatotoxicity of newer drugs approved for IBD, like anti-interleukin 12/23 and tofacitinib, are still scarce, but the evidence from other rheumatic diseases is reassuring. Hepatitis B reactivation during immunosuppressive therapy is a major concern in IBD, and adequate screening and vaccination is warranted. On the other hand, hepatitis C reactivation does not seem to be a real risk, and hepatitis C antiviral treatment does not influence IBD natural history. The approach to an IBD patient with abnormal liver function tests is complex due to the wide range of differential diagnosis, but it is of paramount importance to make a quick and accurate diagnosis, as it may influence the therapeutic management.
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Affiliation(s)
- Stefano Mazza
- Gastroenterology and Digestive Endoscopy Unit, ASST Cremona, Cremona 26100, Italy
| | - Sara Soro
- Gastroenterology and Digestive Endoscopy Unit, ASST Cremona, Cremona 26100, Italy
| | - Maria Chiara Verga
- Gastroenterology and Digestive Endoscopy Unit, ASST Cremona, Cremona 26100, Italy
| | - Biagio Elvo
- Gastroenterology and Digestive Endoscopy Unit, ASST Cremona, Cremona 26100, Italy
| | - Francesca Ferretti
- Gastroenterology Unit, ASST Fatebenefratelli-Sacco, Department of Biomedical and Clinical Sciences (DIBIC), Università degli Studi di Milano, Milan 20157, Italy
| | - Fabrizio Cereatti
- Gastroenterology and Digestive Endoscopy Unit, ASST Cremona, Cremona 26100, Italy
| | - Andrea Drago
- Gastroenterology and Digestive Endoscopy Unit, ASST Cremona, Cremona 26100, Italy
| | - Roberto Grassia
- Gastroenterology and Digestive Endoscopy Unit, ASST Cremona, Cremona 26100, Italy
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Lagrange J, Lacolley P, Wahl D, Peyrin-Biroulet L, Regnault V. Shedding Light on Hemostasis in Patients With Inflammatory Bowel Diseases. Clin Gastroenterol Hepatol 2021; 19:1088-1097.e6. [PMID: 31972287 DOI: 10.1016/j.cgh.2019.12.043] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Revised: 12/19/2019] [Accepted: 12/31/2019] [Indexed: 02/07/2023]
Abstract
Patients with inflammatory bowel diseases (IBD) have an increased risk of thrombosis, possibly due to changes in blood cells and molecules involved in hemostasis. They have increased platelet counts and reactivity as well as increased platelet-derived large extracellular vesicles. Coagulation is continuously activated in patients with IBD, based on measured markers of thrombin generation, and the anticoagulant functions of endothelial cells are damaged. Furthermore, fibrinogen is increased and fibrin clots are denser. However, pathogenesis of thrombosis in patients with IBD appears to differ from that of patients without IBD. Patients with IBD also take drugs that might contribute to risk of thrombosis, complicating the picture. We review the features of homeostasis that are altered in patients with IBD and possible mechanisms of this relationship.
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Affiliation(s)
- Jeremy Lagrange
- INSERM U1116, Faculté de Médecine, Université de Lorraine, Vandœuvre-lès-Nancy, France; Université de Lorraine, Nancy, France; Center for Thrombosis and Hemostasis, University Medical Center Mainz, Mainz, Germany.
| | - Patrick Lacolley
- INSERM U1116, Faculté de Médecine, Université de Lorraine, Vandœuvre-lès-Nancy, France; Université de Lorraine, Nancy, France; Centre Hospitalier Régionale Universitaire de Nancy, Vandœuvre-lès-Nancy, France
| | - Denis Wahl
- INSERM U1116, Faculté de Médecine, Université de Lorraine, Vandœuvre-lès-Nancy, France; Université de Lorraine, Nancy, France; Division of Vascular Medicine, Centre Hospitalier Régionale Universitaire de Nancy, Vandœuvre-lès-Nancy, France
| | - Laurent Peyrin-Biroulet
- Université de Lorraine, Nancy, France; INSERM U1256, Faculté de Médecine, Université de Lorraine, Vandœuvre-lès-Nancy, France; Department of Gastroenterology, Centre Hospitalier Régionale Universitaire de Nancy, Vandœuvre-lès-Nancy, France
| | - Véronique Regnault
- INSERM U1116, Faculté de Médecine, Université de Lorraine, Vandœuvre-lès-Nancy, France; Université de Lorraine, Nancy, France; Centre Hospitalier Régionale Universitaire de Nancy, Vandœuvre-lès-Nancy, France
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8
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Schlick CJR, Yuce TK, Yang AD, McGee MF, Bentrem DJ, Bilimoria KY, Merkow RP. A postdischarge venous thromboembolism risk calculator for inflammatory bowel disease surgery. Surgery 2020; 169:240-247. [PMID: 33077197 DOI: 10.1016/j.surg.2020.09.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 08/26/2020] [Accepted: 09/04/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Guidelines recommend extended chemoprophylaxis for venous thromboembolism in high-risk patients having operations for inflammatory bowel disease. Quantifying patients' risk of venous thromboembolism, however, remains challenging. We sought (1) to identify factors associated with postdischarge venous thromboembolism in patients undergoing colorectal resection for inflammatory bowel disease and (2) to develop a postdischarge venous thromboembolism risk calculator to guide prescribing of extended chemoprophylaxis. METHODS Patients who underwent an operation for inflammatory bowel disease from 2012 to 2018 were identified from the American College of Surgeons National Surgical Quality Improvement Program for colectomy and proctectomy procedure targeted modules. Postdischarge venous thromboembolism included pulmonary embolism or deep vein thrombosis diagnosed after discharge from the index hospitalization. Multivariable logistic regression estimated the association of patient/operative factors with postdischarge venous thromboembolism. A postdischarge venous thromboembolism risk calculator was subsequently constructed. RESULTS Of 18,990 patients, 199 (1.1%) developed a postdischarge venous thromboembolism within the first 30 postoperative days. Preoperative factors associated with postdischarge venous thromboembolism included body mass index (1.9% with body mass index ≥35 vs 0.8% with body mass index 18.5-24.9; odds ratio 2.34 [95% confidence interval 1.49-3.67]), steroid use (1.3% vs 0.7%; odds ratio 1.91 [95% confidence interval 1.37-2.66]), and ulcerative colitis (1.5% vs 0.8% with Crohn's disease; odds ratio 1.76 [95% confidence interval 1.32-2.34]). Minimally invasive surgery was associated with postdischarge venous thromboembolism (1.2% vs 0.9% with open; odds ratio 1.42 [95% confidence interval 1.05-1.92]), as was anastomotic leak (2.8% vs 1.0%; odds ratio 2.24 [95% confidence interval 1.31-3.83]) and ileus (2.1% vs 0.9%; odds ratio 2.60 [95% confidence interval 1.91-3.54]). The predicted probability of postdischarge venous thromboembolism ranged from 0.2% to 14.3% based on individual risk factors. CONCLUSION Preoperative, intraoperative, and postoperative factors are associated with postdischarge venous thromboembolism after an operation for inflammatory bowel disease. A postdischarge venous thromboembolism risk calculator was developed which can be used to tailor extended venous thromboembolism chemoprophylaxis by individual risk.
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Affiliation(s)
- Cary Jo R Schlick
- Surgical Outcomes and Quality Improvement Center, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Tarik K Yuce
- Surgical Outcomes and Quality Improvement Center, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Anthony D Yang
- Surgical Outcomes and Quality Improvement Center, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Michael F McGee
- Surgical Outcomes and Quality Improvement Center, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - David J Bentrem
- Surgical Outcomes and Quality Improvement Center, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL; Surgery Service, Jesse Brown VA Medical Center, Chicago, IL
| | - Karl Y Bilimoria
- Surgical Outcomes and Quality Improvement Center, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL; Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, IL
| | - Ryan P Merkow
- Surgical Outcomes and Quality Improvement Center, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL; Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, IL.
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9
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Zhou X, Lin X, Shen R, Qu Y, Mo C, Li Y, Chen Q, Wu G, Chen Z, Huang K. A retrospective analysis of risk factors associated with catheter-related thrombosis: a single-center study. Perfusion 2020; 35:806-813. [PMID: 32419612 DOI: 10.1177/0267659120915142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Catheter-related thrombosis may lead to catheter infections and failure, further deep venous thrombosis, and pulmonary embolism. Recognizing the risk factors for catheter-related thrombosis is extremely important to inform the development of catheter care guidelines. METHODS Data were collected from a total of 1,532 patients who had undergone venous catheterization, including indwelling catheterization from 19 March 2019 to 30 March 2019 in the Sun Yat-sen Memorial Hospital. The factors for which data were to be collected included the patients' physical characteristics, catheter-related factors, and catheter care-related factors. Logistic regression analysis, the chi-squared test, Fisher's exact test, and the t-test were used to analyze the data. RESULTS Of the 1,532 patients studied, 28 developed intraductal thrombi, and of the factors analyzed, malignancy, a catheterization history, a history of thrombophilia, surgery during the week before catheterization, the catheterization duration, and anticoagulant therapy were significant risk factors associated with catheter-related thrombosis (all p < 0.05). There were no significant associations between the catheter brand, the number of lumens, the insertion direction, or the factors associated with catheter care and catheter-related thrombosis (all p > 0.05). CONCLUSION Our study incorporated clear and systematic risk factors associated with catheter-related thrombosis. Malignancy, history of thrombophilia, history of catheterization, surgery during the week before catheterization, and catheterization duration were associated with increased risks of catheter-related thrombosis. Prophylactic anticoagulation was effective for preventing and treating catheter-related thrombosis.
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Affiliation(s)
- Xuezhen Zhou
- Department of Nursing, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xi Lin
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China
| | - Runnan Shen
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China
| | - Yingying Qu
- Venous Catheter Nursing Clinic, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Chunling Mo
- Venous Catheter Nursing Clinic, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yan Li
- Venous Catheter Nursing Clinic, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Qinchang Chen
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China.,The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Guitao Wu
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China
| | - Zhenhong Chen
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China
| | - Kai Huang
- Department of Cardiovascular Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
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10
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Chanchal S, Mishra A, Singh MK, Ashraf MZ. Understanding Inflammatory Responses in the Manifestation of Prothrombotic Phenotypes. Front Cell Dev Biol 2020; 8:73. [PMID: 32117993 PMCID: PMC7033430 DOI: 10.3389/fcell.2020.00073] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 01/27/2020] [Indexed: 12/23/2022] Open
Abstract
Inflammasome complex is a multimeric protein comprising of upstream sensor protein of nucleotide-binding oligomerization domain (NOD)-like receptor family. It has an adaptor protein apoptosis-associated speck-like protein and downstream effector cysteine protease procaspase-1. Activation of inflammasome complex is body’s innate response to pathogen attack but its abnormal activation results in many inflammatory and cardiovascular disorders including thrombosis. It has displayed a prominent role in the clot formation advocating an interplay between inflammation and coagulation cascades. Therefore, elucidation of inflammasome and its molecular mechanisms in the manifestation of prothrombotic phenotypes becomes pertinent. Thrombosis is the formation and propagation of blood clot in the arterial or venous system due to several interactions of vascular and immune factors. It is a prevalent pathology underlying disorders like venous thromboembolism, stroke and acute coronary syndrome; thus, making thrombosis, a major contributor to the global disease burden. Recently studies have established a strong connection of inflammatory processes with this blood coagulation disorder. The hemostatic balance in thrombosis gets altered by the inflammatory mechanisms resulting in endothelial and platelet activation that subsequently increases secretion of several prothrombotic and antifibrinolytic factors. The upregulation of these factors is the critical event in the pathogenesis of thrombosis. Among various inflammasome, nucleotide-binding domain, leucine-rich-containing family, pyrin domain containing 3 (NLRP3) is one of the best-studied sterile inflammasome strengthening a link between inflammation and coagulation in thrombosis. NLRP3 activation results in the catalytic conversion of procaspase-1 to active caspase-1, which facilitate the maturation of interleukin-1β (IL-1β) and interleukin-18. These cytokines are responsible for immune cells activation critical for immune responses. These responses further results in endothelial and platelet activation and aggregation. However, the exact molecular mechanism related to the pathogenesis of thrombosis is still elusive. There have been several reports that demonstrate Tissue factor (TF)-mediated signaling in the production of pro-inflammatory cytokines enhancing inflammation by activating protease-activated receptors on various cells, which lead to additional cytokine expression. Therefore, it would be illuminating to interpret the inflammasomes regulation in coagulation and inflammation. This review, thus, tries to comprehensively compile emerging regulatory roles of the inflammasomes in thrombosis and discusses their molecular pathways in the manifestation of thrombotic phenotypes.
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Affiliation(s)
- Shankar Chanchal
- Department of Biotechnology, Faculty of Natural Sciences, Jamia Millia Islamia, New Delhi, India
| | - Aastha Mishra
- Department of Biotechnology, Faculty of Natural Sciences, Jamia Millia Islamia, New Delhi, India
| | - Manvendra Kumar Singh
- Signature Research Program in Cardiovascular and Metabolic Disorders, Duke-NUS Graduate Medical School Singapore, National Heart Centre Singapore, Singapore, Singapore
| | - Mohammad Zahid Ashraf
- Department of Biotechnology, Faculty of Natural Sciences, Jamia Millia Islamia, New Delhi, India
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Mitchel E, Diamond T, Albenberg L. Venous Thrombosis in Pediatric Inflammatory Bowel Disease. J Pediatr 2020; 216:213-217. [PMID: 31610937 DOI: 10.1016/j.jpeds.2019.09.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 08/30/2019] [Accepted: 09/13/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Elana Mitchel
- Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Tamir Diamond
- Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Philadelphia, Philadelphia, PA.
| | - Lindsey Albenberg
- Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Philadelphia, Philadelphia, PA
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12
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Deskur A, Zawada I, Błogowski W, Starzyńska T. Cerebral venous sinus thrombosis in a young patient with ulcerative colitis: A case report. Medicine (Baltimore) 2019; 98:e17428. [PMID: 31593096 PMCID: PMC6799827 DOI: 10.1097/md.0000000000017428] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
RATIONALE Cerebral venous sinus thrombosis (CVST) represents one of the most alarming forms of hemostatic abnormalities that may occur in patients with inflammatory bowel diseases (IBDs). PATIENT CONCERNS Here we report a case of a 25-year-old male with ulcerative colitis, who developed such thromboembolic complication during flare of the disease. CVST in our patient was clinically manifested by headache and nausea. DIAGNOSIS Angio-magnetic resonance imaging scan of the head revealed segments of contrast filling defects/absence indicating right dural venous sinus thrombosis of the transverse sinus. INTERVENTION Immediate treatment with low-molecular-weight heparin has been introduced and led to full remission of symptoms and total recanalization of the thrombotic cerebral regions. OUTCOMES Currently (over 2 years after diagnosis) the patient is in remission of the disease, and no further thromboembolic complications have been observed. LESSONS Our case study highlights the clinical difficulties and challenges associated with diagnosis and treatment of CVST, as well as presents the current state of knowledge about this complication among patients with IBDs. Physicians taking care of IBD patients should be aware of this alarming hemostatic abnormality.
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Affiliation(s)
- Anna Deskur
- Department of Gastroenterology, Pomeranian Medical University, Szczecin
| | - Iwona Zawada
- Department of Gastroenterology, Pomeranian Medical University, Szczecin
| | - Wojciech Błogowski
- Department of Internal Medicine, University of Zielona Góra, Zielona Góra, Poland
| | - Teresa Starzyńska
- Department of Gastroenterology, Pomeranian Medical University, Szczecin
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Crohn's Disease Complicated With Extensive Thrombosis of Limbs and Mesenteric Arteries: A Case Report and Literature Review. Ann Vasc Surg 2019; 58:382.e15-382.e19. [PMID: 30802583 DOI: 10.1016/j.avsg.2018.12.079] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Revised: 10/18/2018] [Accepted: 12/05/2018] [Indexed: 11/21/2022]
Abstract
BACKGROUND Crohn's disease (CD) is a lifelong disease characterized by purulent inflammation in the gastrointestinal tract from any part of the mouth to the anus. Various studies have reported complications of the CD. However, arterial thrombosis is an extremely rare complication of CD. We report a patient with CD with extensive thrombosis of the extremities and mesenteric arteries. METHODS A 41-year-old man came to our hospital for 2 months of discomfort in the right upper abdomen and had previous left lower extremity arterial occlusive disease and left upper limb ischemic contraction for more than 2 months. The patient developed fever and abdominal pain repeatedly after admission; because of the increased abdominal pain, we urgently performed a laparotomy for him. And according to the findings in the surgery, we decided to perform partial small intestine resection, cholecystectomy, common bile duct exploration, and T-tube drainage. RESULTS Pathological findings of postoperative specimens showed Crohn's disease and mesenteric atherosclerosis with mesenteric artery thrombosis. We performed a series of treatments such as 5-aminosalicylic acid, intravenous infusion, broad-spectrum antibiotic infection treatment, nutritional support, and low molecular weight heparin. The patient was successfully discharged from the hospital. CONCLUSIONS The occurrence of IBD with arterial thromboembolism is extremely rare but can lead to serious consequences. During IBD treatment, we should be aware of the possibility of TEs (especially arterial TEs) and should be alert to the possibility of arterial TEs in young patients with IBD with active and extensive disease.
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Ito S, Higashiyama M, Horiuchi K, Mizoguchi A, Soga S, Tanemoto R, Nishii S, Terada H, Wada A, Sugihara N, Hanawa Y, Furuhashi H, Takajo T, Shirakabe K, Watanabe C, Komoto S, Tomita K, Nagao S, Shinozaki M, Nakagawa A, Kubota M, Miyagishima D, Gotoh N, Miura S, Ueno H, Hokari R. Atypical Clinical Presentation of Crohn's Disease with Superior Mesenteric Vein Obstruction and Protein-losing Enteropathy. Intern Med 2019; 58:369-374. [PMID: 30210116 PMCID: PMC6395114 DOI: 10.2169/internalmedicine.1192-18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
We herein report a 44-year-old man suffering from systemic edema due to protein-losing enteropathy (PLE) with superior mesenteric vein (SMV) obstruction and development of collateral veins, which subsequently proved to be a chronic result of thrombosis and a complication of Crohn's disease (CD). PLE was supposedly induced by both intestinal erosion and thrombosis-related lymphangiectasia, which was histologically proven in his surgically-resected ileal stenosis. Elemental diet and anti-TNFα agent improved his hypoalbuminemia after surgery. The rarity of the simultaneous coexistence of SMV obstruction and PLE and the precedence of these complications over typical abdominal symptoms of CD made the clinical course complex.
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Affiliation(s)
- Suguru Ito
- Department of Internal Medicine, National Defense Medical College, Japan
| | | | - Kazuki Horiuchi
- Department of Internal Medicine, National Defense Medical College, Japan
| | - Akinori Mizoguchi
- Department of Internal Medicine, National Defense Medical College, Japan
| | - Shigeyoshi Soga
- Department of Radiology, National Defense Medical College, Japan
| | - Rina Tanemoto
- Department of Internal Medicine, Self Defense Forces Central Hospital, Japan
| | - Shin Nishii
- Department of Internal Medicine, National Defense Medical College, Japan
| | - Hisato Terada
- Department of Internal Medicine, National Defense Medical College, Japan
| | - Akinori Wada
- Department of Internal Medicine, National Defense Medical College, Japan
| | - Nao Sugihara
- Department of Internal Medicine, National Defense Medical College, Japan
| | - Yoshinori Hanawa
- Department of Internal Medicine, National Defense Medical College, Japan
| | - Hirotaka Furuhashi
- Department of Internal Medicine, National Defense Medical College, Japan
| | - Takeshi Takajo
- Department of Internal Medicine, National Defense Medical College, Japan
| | - Kazuhiko Shirakabe
- Department of Internal Medicine, National Defense Medical College, Japan
| | - Chikako Watanabe
- Department of Internal Medicine, National Defense Medical College, Japan
| | - Shunsuke Komoto
- Department of Internal Medicine, National Defense Medical College, Japan
| | - Kengo Tomita
- Department of Internal Medicine, National Defense Medical College, Japan
| | - Shigeaki Nagao
- Department of Internal Medicine, National Defense Medical College, Japan
| | | | | | - Michio Kubota
- Department of Gastroenterology, Numazu City Hospital, Japan
| | | | - Nobuaki Gotoh
- Department of Gastroenterology, Numazu City Hospital, Japan
| | - Soichiro Miura
- Department of Internal Medicine, National Defense Medical College, Japan
| | - Hideki Ueno
- Department of Surgery, National Defense Medical College, Japan
| | - Ryota Hokari
- Department of Internal Medicine, National Defense Medical College, Japan
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15
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Bohra GK, Chhabra V, Midha N, Sureka B. Budd-Chiari syndrome in a patient with ulcerative colitis. BMJ Case Rep 2018; 2018:bcr-2017-222300. [DOI: 10.1136/bcr-2017-222300] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Increased Rate of Venous Thromboembolism in Hospitalized Inflammatory Bowel Disease Patients with Clostridium Difficile Infection. Inflamm Bowel Dis 2017; 23:1847-1852. [PMID: 28837518 DOI: 10.1097/mib.0000000000001218] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Risk of venous thromboembolism (VTE) in patients with inflammatory bowel disease (IBD) is well established; however, there is paucity of data on the potential added risk of VTE in patients with IBD with Clostridium difficile infection (CDI). We sought to study the difference in VTE rates in hospitalized patients with IBD with CDI compared to those without CDI. METHODS We queried Nationwide Inpatient Sample from year 2011 to identify patients ≥18 years of age with a discharge diagnosis of IBD (i.e., Crohn's disease and ulcerative colitis) based on ICD-9-CM codes 555.xx and 556.xx, respectively. Patients were further divided into 2 groups: those with and without CDI. To adjust and control for potential baseline differences between groups, 1:1 propensity matching was performed. Multivariate regression analysis was used to evaluate the difference in VTE rates in 2 groups. RESULTS Of 312,147 patients with the discharge diagnosis of IBD, 12,560 (4%) had CDI. VTE was present 6% in group with CDI versus 3% in group without CDI (P < 0.001). On performing multivariate analysis after propensity-score matching, CDI was significantly associated with VTE (adjusted odds ratio 1.7, 95% confidence interval 1.4-2.2, P < 0.001). On subgroup analysis, Crohn's disease with CDI had a higher association with VTE compared with Crohn's disease only. Similarly, ulcerative colitis with CDI had a higher association with VTE compared with ulcerative colitis only. CONCLUSIONS Rate of VTE was higher in hospitalized patients with IBD with CDI compared with those without CDI, necessitating extra vigilance in this patient population.
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17
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Olpin JD, Sjoberg BP, Stilwill SE, Jensen LE, Rezvani M, Shaaban AM. Beyond the Bowel: Extraintestinal Manifestations of Inflammatory Bowel Disease. Radiographics 2017; 37:1135-1160. [PMID: 28548906 DOI: 10.1148/rg.2017160121] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Inflammatory bowel disease (IBD) is a chronic, relapsing immune-mediated inflammation of the gastrointestinal tract. IBD includes two major disease entities: Crohn disease and ulcerative colitis. Imaging plays an important role in the diagnosis and surveillance of these complex disorders. Computed tomographic and magnetic resonance enterographic techniques have been refined in recent years to provide a superb means of evaluating the gastrointestinal tract for suspected IBD. Although the intestinal imaging manifestations of IBD have been extensively discussed in the radiology literature, extraintestinal imaging manifestations of IBD have received less attention. Multiple extraintestinal manifestations may be seen in IBD, including those of gastrointestinal (hepatobiliary and pancreatic), genitourinary, musculoskeletal, pulmonary, cardiac, ocular, and dermatologic disorders. Although many associations between IBD and extraintestinal organ systems have been well established, other associations have not been fully elucidated. Some extraintestinal disorders may share a common pathogenesis with IBD. Other extraintestinal disorders may occur as a result of unintended treatment-related complications of IBD. Although extraintestinal disorders within the abdomen and pelvis may be well depicted with cross-sectional enterography, other musculoskeletal and thoracic disorders may be less evident with such examinations and may warrant further investigation with additional imaging examinations or may be readily apparent from the findings at physical examination. Radiologists involved in the interpretation of IBD imaging examinations must be aware of potential extraintestinal manifestations, to provide referring clinicians with an accurate and comprehensive profile of patients with these complex disorders. © RSNA, 2017.
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Affiliation(s)
- Jeffrey D Olpin
- From the Department of Diagnostic Radiology (J.D.O., S.E.S., L.E.J., M.R., A.M.S.), University of Utah, 30 North 1900 East, #1A71, Salt Lake City, UT 84132; and the Department of Diagnostic Radiology, University of Wisconsin, Madison, Wis (B.P.S.)
| | - Brett P Sjoberg
- From the Department of Diagnostic Radiology (J.D.O., S.E.S., L.E.J., M.R., A.M.S.), University of Utah, 30 North 1900 East, #1A71, Salt Lake City, UT 84132; and the Department of Diagnostic Radiology, University of Wisconsin, Madison, Wis (B.P.S.)
| | - Sarah E Stilwill
- From the Department of Diagnostic Radiology (J.D.O., S.E.S., L.E.J., M.R., A.M.S.), University of Utah, 30 North 1900 East, #1A71, Salt Lake City, UT 84132; and the Department of Diagnostic Radiology, University of Wisconsin, Madison, Wis (B.P.S.)
| | - Leif E Jensen
- From the Department of Diagnostic Radiology (J.D.O., S.E.S., L.E.J., M.R., A.M.S.), University of Utah, 30 North 1900 East, #1A71, Salt Lake City, UT 84132; and the Department of Diagnostic Radiology, University of Wisconsin, Madison, Wis (B.P.S.)
| | - Maryam Rezvani
- From the Department of Diagnostic Radiology (J.D.O., S.E.S., L.E.J., M.R., A.M.S.), University of Utah, 30 North 1900 East, #1A71, Salt Lake City, UT 84132; and the Department of Diagnostic Radiology, University of Wisconsin, Madison, Wis (B.P.S.)
| | - Akram M Shaaban
- From the Department of Diagnostic Radiology (J.D.O., S.E.S., L.E.J., M.R., A.M.S.), University of Utah, 30 North 1900 East, #1A71, Salt Lake City, UT 84132; and the Department of Diagnostic Radiology, University of Wisconsin, Madison, Wis (B.P.S.)
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18
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Tian LL, Huang LY. Inflammatory bowel disease and thromboembolic events. Shijie Huaren Xiaohua Zazhi 2017; 25:589-595. [DOI: 10.11569/wcjd.v25.i7.589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Thromboembolism (TE) is an extraintestinal manifestation (EIM) of inflammatory bowel disease (IBD). According to previous pathological reports, the incidence of IBD complicated with TE is as high as 41%. However, this EIM is often overlooked. This review summarizes the results of the relevant clinical studies to date, analyzes the potential prothrombotic risk of IBD drug therapy, and discusses the current status on the treatment and prevention of TE, with an aim to provide a comprehensive reference for clinical work.
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Jacinto AML, Ridyard AE, Aroch I, Watson PJ, Morrison LR, Chandler ML, Kuzi S. Thromboembolism in Dogs with Protein-Losing Enteropathy with Non-Neoplastic Chronic Small Intestinal Disease. J Am Anim Hosp Assoc 2016; 53:185-192. [PMID: 27841681 DOI: 10.5326/jaaha-ms-6328] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Dogs with protein-losing enteropathy (PLE) are suggested to be at increased risk of developing thromboembolic events. However, with some exceptions, there are very few reports of thromboembolism in such dogs. This multicentre retrospective observational study describes a case series of thromboembolism (TE) in eight dogs with PLE secondary to non-neoplastic, chronic small intestinal disease. Seven dogs had poorly controlled PLE when the thromboembolic event occurred. Pulmonary thromboembolism (PTE) occurred in six dogs, while one dog developed splenic vein thrombosis and another had concurrent splenic vein and aortic TE. Six dogs died, all with PTE. Antithrombin activity was decreased in one of two dogs in which it was measured. Serum cobalamin and folate concentrations were measured in three dogs and cobalamin was subnormal in all three. Serum magnesium, measured in two dogs, was low in both. Dogs with uncontrolled chronic small intestinal disease and PLE are at risk for developing serious life-threatening TE, mostly PTE.
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Affiliation(s)
| | - Alison E Ridyard
- From the Division of Veterinary Clinical Sciences (A.M.L.J., A.E.R., M.L.C.) and Easter Bush Pathology (L.R.M.), Royal (Dick) School of Veterinary Studies and the Roslin Institute, University of Edinburgh, Edinburgh, Scotland, United Kingdom; Koret School of Veterinary Medicine, the Robert H. Smith Faculty of Agricultural, the Hebrew University of Jerusalem, Rehovot, Israel (S.K., I.A.); and the Queen's Veterinary School Hospital, University of Cambridge, Cambridge, England, United Kingdom (P.J.W.)
| | | | - Penny J Watson
- From the Division of Veterinary Clinical Sciences (A.M.L.J., A.E.R., M.L.C.) and Easter Bush Pathology (L.R.M.), Royal (Dick) School of Veterinary Studies and the Roslin Institute, University of Edinburgh, Edinburgh, Scotland, United Kingdom; Koret School of Veterinary Medicine, the Robert H. Smith Faculty of Agricultural, the Hebrew University of Jerusalem, Rehovot, Israel (S.K., I.A.); and the Queen's Veterinary School Hospital, University of Cambridge, Cambridge, England, United Kingdom (P.J.W.)
| | - Linda R Morrison
- From the Division of Veterinary Clinical Sciences (A.M.L.J., A.E.R., M.L.C.) and Easter Bush Pathology (L.R.M.), Royal (Dick) School of Veterinary Studies and the Roslin Institute, University of Edinburgh, Edinburgh, Scotland, United Kingdom; Koret School of Veterinary Medicine, the Robert H. Smith Faculty of Agricultural, the Hebrew University of Jerusalem, Rehovot, Israel (S.K., I.A.); and the Queen's Veterinary School Hospital, University of Cambridge, Cambridge, England, United Kingdom (P.J.W.)
| | - Marge L Chandler
- From the Division of Veterinary Clinical Sciences (A.M.L.J., A.E.R., M.L.C.) and Easter Bush Pathology (L.R.M.), Royal (Dick) School of Veterinary Studies and the Roslin Institute, University of Edinburgh, Edinburgh, Scotland, United Kingdom; Koret School of Veterinary Medicine, the Robert H. Smith Faculty of Agricultural, the Hebrew University of Jerusalem, Rehovot, Israel (S.K., I.A.); and the Queen's Veterinary School Hospital, University of Cambridge, Cambridge, England, United Kingdom (P.J.W.)
| | - Sharon Kuzi
- From the Division of Veterinary Clinical Sciences (A.M.L.J., A.E.R., M.L.C.) and Easter Bush Pathology (L.R.M.), Royal (Dick) School of Veterinary Studies and the Roslin Institute, University of Edinburgh, Edinburgh, Scotland, United Kingdom; Koret School of Veterinary Medicine, the Robert H. Smith Faculty of Agricultural, the Hebrew University of Jerusalem, Rehovot, Israel (S.K., I.A.); and the Queen's Veterinary School Hospital, University of Cambridge, Cambridge, England, United Kingdom (P.J.W.)
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20
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Brown SR, Coviello LC. Extraintestinal Manifestations Associated with Inflammatory Bowel Disease. Surg Clin North Am 2016; 95:1245-59, vii. [PMID: 26596925 DOI: 10.1016/j.suc.2015.08.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Inflammatory bowel disease (IBD) affects multiple organ systems outside of the gastrointestinal tract. The clinician treating patients with IBD should be acutely aware of the diagnosis and treatment of extraintestinal manifestations in order to decrease morbidity. The management can be difficult and often times requires a multidisciplinary approach. Future research investigating the pathophysiology, diagnosis, and treatment is needed to further the care of these patients.
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Affiliation(s)
- Shaun R Brown
- Department of Colorectal Surgery, Oschner Clinic Foundation, New Orleans, LA, USA; Department of Surgery, Uniformed Services University of Health Sciences, Bethesda, MD 20814, USA
| | - Lisa C Coviello
- Department of Surgery, National Capital Region Medical Directorate, Fort Belvoir, VA 22060, USA; Department of Surgery of the Uniformed Services University of Health Sciences and the Walter Reed National Military Medical Center, Bethesda, MD 20814, USA.
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21
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Gan GH, Yang LM, Wang J. Thrombotic mechanism and anticoagulant therapy in inflammatory bowel disease patients. Shijie Huaren Xiaohua Zazhi 2016; 24:236-241. [DOI: 10.11569/wcjd.v24.i2.236] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Thromboembolism (TE) in inflammatory bowel disease (IBD) is an increasingly noted extra-intestinal manifestation with high morbidity (about 1%-8%), and the incidence rate can reach 41% by mucosal biopsy. Although TE is a life-threatening complication of IBD, this complication is often overlooked. To date, the mechanism behind this prothrombotic state encountered in IBD patients is not fully understood, and it is multifactorial and related to the inflammatory state. In this review, we provide an overview of the current understanding of thrombotic mechanism and anticoagulant therapy in IBD. While controlling the activity of the disease with appropriate therapy, thromboembolism prophylaxis should be considered.
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22
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Kim I, Min KH, Yeo M, Kim JS, Lee SH, Lee SS, Shin KS, Youn SJ, Shin DI. Unusual Case of Cerebral Venous Thrombosis in Patient with Crohn's Disease. Case Rep Neurol 2015; 7:115-20. [PMID: 26078745 PMCID: PMC4463793 DOI: 10.1159/000430805] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
The development of cerebral venous thrombosis (CVT) as a secondary complication of Crohn's disease (CD) seems to be rare, but it is generally accepted that the disease activity of CD contributes to the establishment of a hypercoagulable state. Here, we describe a case of CVT that developed outside the active phase of CD. A 17-year-old male visited the emergency room because of a sudden onset of right-sided weakness and right-sided hypesthesia. He had been diagnosed with CD 1 year before and was on a maintenance regimen of mesalazine and azathioprine. He did not exhibit any symptoms indicating a CD flare-up (bloody stools, abdominal pain, complications, or weight loss). A brain MRI scan revealed an acute infarction of the left frontal cortex and a cortical subarachnoid hemorrhage. Additionally, a magnetic resonance venography revealed a segmental filling defect in the superior sagittal sinus and also the non-visualizability of some bilateral cortical veins. The characteristics of the present case suggest that the risk of CVT is most likely related to CD per se rather than disease activity associated with CD.
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Affiliation(s)
- Inha Kim
- Neurology, Chungbuk National University Hospital, Cheongju, Korea
| | - Kyung-Hyun Min
- Neurology, Chungbuk National University Hospital, Cheongju, Korea
| | - Minju Yeo
- Neurology, Chungbuk National University Hospital, Cheongju, Korea
| | - Ji Seon Kim
- Department of Neurology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Sung Hyun Lee
- Department of Neurology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Sang Soo Lee
- Department of Neurology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Kyeong Seob Shin
- Department of Laboratory Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Sei Jin Youn
- Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Dong Ick Shin
- Department of Neurology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
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Giannotta M, Tapete G, Emmi G, Silvestri E, Milla M. Thrombosis in inflammatory bowel diseases: what's the link? Thromb J 2015; 13:14. [PMID: 25866483 PMCID: PMC4393581 DOI: 10.1186/s12959-015-0044-2] [Citation(s) in RCA: 92] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Accepted: 02/26/2015] [Indexed: 12/11/2022] Open
Abstract
Inflammatory bowel disease affects more than 2 million people in Europe, with almost 20% of patients being diagnosed in pediatric age. Patients with inflammatory bowel disease are at increased risk of thromboembolic complications which may affect patients’ morbidity and mortality. The risk of the most common thromboembolic events, such as deep venous thrombosis and pulmonary embolism, are estimated to be three-fold increased compared to controls, but many other districts can be affected. Moreover, patients with ulcerative colitis and Crohn’s disease experience thromboembolic events at a younger age compared to general population. Many factors have been investigated as determinants of the pro-thrombotic tendency such as acquired risk factors or genetic and immune abnormalities, but a unique cause has not been found. Many efforts have been focused on the study of abnormalities in the coagulation cascade, its natural inhibitors and the fibrinolytic system components and both quantitative and qualitative alterations have been demonstrated. Recently the role of platelets and microvascular endothelium has been reviewed, as the possible link between the inflammatory and hemostatic process.
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Affiliation(s)
- Martina Giannotta
- Gastroenterology Department, AOU Careggi Regional Referral Center for Inflammatory Bowel Disease, Florence, Italy
| | - Gherardo Tapete
- Gastroenterology Department, AOU Careggi Regional Referral Center for Inflammatory Bowel Disease, Florence, Italy
| | - Giacomo Emmi
- Department of Experimental and Clinical Medicine, University of Florence and Patologia Medica Unit, AOU Careggi, Florence, Italy
| | - Elena Silvestri
- Department of Experimental and Clinical Medicine, University of Florence and Patologia Medica Unit, AOU Careggi, Florence, Italy
| | - Monica Milla
- Gastroenterology Department, AOU Careggi Regional Referral Center for Inflammatory Bowel Disease, Florence, Italy
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Higgins PDR, Skup M, Mulani PM, Lin J, Chao J. Increased risk of venous thromboembolic events with corticosteroid vs biologic therapy for inflammatory bowel disease. Clin Gastroenterol Hepatol 2015; 13:316-21. [PMID: 25038374 DOI: 10.1016/j.cgh.2014.07.017] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Revised: 06/10/2014] [Accepted: 07/02/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS We investigated whether treatment of active inflammatory bowel disease with biologic agents is associated with a reduced risk of venous thromboembolic events (VTEs) compared with corticosteroid therapy. METHODS We performed a retrospective analysis of 15,100 adults with inflammatory bowel disease who were identified from the Truven Health MarketScan databases. We analyzed data from patients who received 6 months of continuous medical and prescription coverage before and 12 months after their first diagnosis and had no VTE during the 6 months before they first received biologic or corticosteroid therapy. The outcome assessed was any VTE that occurred during the 12-month follow-up period. A multivariate logistic regression model was used to evaluate the effects of biologic, corticosteroid, and combination therapies (biologics and corticosteroids) on VTE risk. RESULTS Three hundred twenty-five VTEs occurred during the study period (in 2.25% of patients receiving only corticosteroids, in 0.44% of patients receiving biologics, and in 2.49% of patients receiving combination therapy). Compared with patients receiving only corticosteroids, the odds ratio for VTE in patients receiving only biologics was 0.21 (95% confidence interval, 0.05-0.87) in the multivariate model, and the odds ratio for VTE in patients on combination therapy was 1.01. CONCLUSIONS Compared with treatment with only a biologic agent, corticosteroid therapy is associated with a nearly 5-fold increase in risk for VTE. Combination therapy with corticosteroids and biologic agents was associated with the same risk for VTE as that of corticosteroids alone. Corticosteroids therefore appear to increase risk for VTE.
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Affiliation(s)
- Peter D R Higgins
- Division of Gastroenterology, Department of Medicine, University of Michigan, Ann Arbor, Michigan.
| | - Martha Skup
- Global Health Economics and Outcomes Research, AbbVie Inc, North Chicago, Illinois
| | - Parvez M Mulani
- Global Health Economics and Outcomes Research, AbbVie Inc, North Chicago, Illinois
| | - Jay Lin
- Novosys Health, Flemington, New Jersey
| | - Jingdong Chao
- Global Health Economics and Outcomes Research, AbbVie Inc, North Chicago, Illinois
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Abstract
BACKGROUND Inflammatory bowel disease confers a hypercoagulable state. A large number of these patients require central venous access in the form of peripherally inserted central catheters for long-term intravenous therapies. Our clinical observations suggested that these patients had a higher incidence of catheter-associated deep venous thrombosis than that of the general population. OBJECTIVE The aim of this study was to examine the relationship between IBD and catheter-associated deep venous thrombosis. DESIGN A retrospective chart review was conducted of all patients who underwent peripherally inserted central catheter line placement between 2009 and 2011. SETTING This study was performed at a single-institution tertiary referral center. PATIENTS All patients who underwent peripherally inserted central catheter line placement were identified. OUTCOME MEASURES The risk of catheter-associated deep venous thrombosis in IBD patients was assessed. This risk was compared with known risk factors such as malnutrition, malignancy, diabetes mellitus, and tobacco use. Multivariate analysis was performed. Catheter size, indication for placement, and vein location of catheter-associated deep venous thrombosis were identified in the IBD population. RESULTS There were 7179 peripherally inserted central catheter lines placed during the study period; the overall incidence of catheter-associated deep venous thrombosis was 2.1% (148/7179). The incidence of catheter-associated deep venous thrombosis among patients with IBD was 6.8% (9/132). The incidence of catheter-associated deep venous thrombosis among non-IBD patients was 1.9% (139/7047) (relative risk, 3.5; 95% CI, 1.8-6.6; p < 0.001). The incidence of catheter-associated deep venous thrombosis was increased for patients with malnutrition (4.8%, 30/628, p < 0.001) and increasing age (95% CI, 1.01-1.12; p = 0.02). There was no increased incidence of catheter-associated deep venous thrombosis for patients with diabetes mellitus (1.6%, 25/1574, p < 0.14), malignancy (2.8%, 30/1041, p = 0.06), or tobacco use (1.6%, 31/1938, p = 0.10). After multivariate analysis, IBD, malnutrition, and increasing age were found to be significant risk factors for the development of catheter-associated deep venous thrombosis. LIMITATIONS The inability to track the number of catheter days, the inaccuracy of administrative data, the lack of outpatient follow-up, and the small number of events in the study cohort were limitations of this study. CONCLUSIONS This is the first study to demonstrate IBD as an independent risk factor to the development of catheter-associated deep venous thrombosis. The placement of a peripherally inserted central catheter line in IBD should be utilized selectively.
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Li YL, Huang SP, Chen Y. Refractory and active ulcerative colitis complicated by venous thrombosis: a case report. ACTA ACUST UNITED AC 2014; 29:242-4. [PMID: 25429751 DOI: 10.1016/s1001-9294(14)60079-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Yu-ling Li
- Department of Gastroenterology, Guangdong Provincial Hospital of Traditional Chinese Medicine, Second Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou 510370, China
| | - Sui-ping Huang
- Department of Gastroenterology, Guangdong Provincial Hospital of Traditional Chinese Medicine, Second Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou 510370, China
| | - Yan Chen
- Department of Gastroenterology, Guangdong Provincial Hospital of Traditional Chinese Medicine, Second Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou 510370, China
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Allaix ME, Krane MK, Zoccali M, Umanskiy K, Hurst R, Fichera A. Postoperative portomesenteric venous thrombosis: lessons learned from 1,069 consecutive laparoscopic colorectal resections. World J Surg 2014; 38:976-84. [PMID: 24240673 DOI: 10.1007/s00268-013-2336-7] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Portomesenteric venous thrombosis (PVT) is a known complication after open and laparoscopic colorectal (LCR) surgery. Risk factors and the prognosis of PVT have been poorly described. METHODS This study is a retrospective analysis of a prospectively collected database. Patients with new-onset postoperative abdominal pain were evaluated with a computed tomography scan of the abdomen. Patients found to have PVT were analyzed. A multivariate analysis was performed to identify predictors of PVT. RESULTS A total of 1,069 patients undergoing LCR surgery for inflammatory bowel disease (IBD) or nonmetastatic cancer between June 2002 and June 2012 were included. Altogether, 37 (3.5 %) patients experienced symptomatic postoperative PVT. On univariate analysis, IBD (p < 0.001), ulcerative colitis (p = 0.016), preoperative therapy with steroids (p = 0.008), operative time ≥220 min (p = 0.004), total proctocolectomy (TPC) (p < 0.001), ileoanal pouch anastomosis (p = 0.006), and postoperative intraabdominal septic complications (p < 0.001) were found to be significant risk factors. By multivariate analysis, TPC (p = 0.026) and postoperative intraabdominal septic complications (p < 0.001) were independent predictors of PVT. In the PVT group, postoperative length of stay was longer (14.8 vs. 7.4 days, p < 0.001). Of the patients evaluated with a hematologic workup, 72.7 % were found to have a hypercoagulable condition. All patients were managed with oral anticoagulation for at least 6 months. No death or complications related to PVT occurred. CONCLUSIONS PVT is a potentially serious complication that is more likely to occur after TPC and in the presence of postoperative intraabdominal septic complications, particularly in patients with a coagulation disorder. Prompt diagnosis and treatment with oral anticoagulation are recommended to avoid long-term sequelae.
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Affiliation(s)
- Marco E Allaix
- Department of Surgery, University of Chicago Medical Center, MC 5095, 5841 S. Maryland Avenue, Chicago, IL, 60637, USA,
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Zezos P, Kouklakis G, Saibil F. Inflammatory bowel disease and thromboembolism. World J Gastroenterol 2014; 20:13863-78. [PMID: 25320522 PMCID: PMC4194568 DOI: 10.3748/wjg.v20.i38.13863] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Revised: 05/24/2014] [Accepted: 06/26/2014] [Indexed: 02/06/2023] Open
Abstract
Patients with inflammatory bowel disease (IBD) have an increased risk of vascular complications. Thromboembolic complications, both venous and arterial, are serious extraintestinal manifestations complicating the course of IBD and can lead to significant morbidity and mortality. Patients with IBD are more prone to thromboembolic complications and IBD per se is a risk factor for thromboembolic disease. Data suggest that thrombosis is a specific feature of IBD that can be involved in both the occurrence of thromboembolic events and the pathogenesis of the disease. The exact etiology for this special association between IBD and thromboembolism is as yet unknown, but it is thought that multiple acquired and inherited factors are interacting and producing the increased tendency for thrombosis in the local intestinal microvasculature, as well as in the systemic circulation. Clinicians' awareness of the risks, and their ability to promptly diagnose and manage tromboembolic complications are of vital importance. In this review we discuss how thromboembolic disease is related to IBD, specifically focusing on: (1) the epidemiology and clinical features of thromboembolic complications in IBD; (2) the pathophysiology of thrombosis in IBD; and (3) strategies for the prevention and management of thromboembolic complications in IBD patients.
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Abstract
Patients with inflammatory bowel diseases (IBDs) may present with several hepatic abnormalities. Some of these liver diseases are benign and only require observation, whereas others may cause liver failure and require liver transplantation. The aim of this review was to present and summarize the latest evidence on the most common liver diseases seen in patients with IBD. These manifestations can be divided in to 3 groups: those that are seen in association with IBD, those that are due to metabolic and physiologic changes induced by the IBD and those that are secondary to the drugs used in the treatment of IBD. Primary sclerosing cholangitis is one of the most common hepatobiliary manifestations of IBD that is more prevalent in patients with ulcerative colitis. There is no approved medical treatment for primary sclerosing cholangitis and about 50% of patients will require liver transplantation within 10 to 15 years from the time of diagnosis. Among the drugs that are commonly used in the treatment of IBD, thiopurines and methotrexate impose the higher risk of hepatotoxicity. In most cases, dose adjustment and avoidance of hepatotoxins will normalize the liver tests and discontinuation of the drug is required in a minority of cases. Reactivation of hepatitis B virus during immunosuppressive therapy is a major concern and adequate screening and vaccination is warranted. The approach to a patient with IBD who presents with abnormal liver chemistries can be challenging not only because 2 or more conditions can co-exist but also because management must be individualized.
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Voudoukis E, Karmiris K, Koutroubakis IE. Multipotent role of platelets in inflammatory bowel diseases: A clinical approach. World J Gastroenterol 2014; 20:3180-3190. [PMID: 24696603 PMCID: PMC3964390 DOI: 10.3748/wjg.v20.i12.3180] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Accepted: 01/20/2014] [Indexed: 02/06/2023] Open
Abstract
There is evidence that inflammatory bowel diseases (IBD) combine both inflammation and coagulation in their pathogenesis and clinical manifestations. Although platelets (PLT) are well known for their role in hemostasis, there are a rising number of studies supporting their considerable role as inflammatory amplifiers in chronic inflammatory conditions. IBD are associated with several alterations of PLT, including number, shape, and function, and these abnormalities are mainly attributed to the highly activated state of circulating PLT in IBD patients. When PLT activate, they increase in size, release a great variety of bio-active inflammatory and procoagulant molecules/particles, and express a variety of inflammatory receptors. These inflammatory products may represent a part of the missing link between coagulation and inflammation, and can be considered as possible IBD pathogenesis instigators. In clinical practice, thrombocytosis is associated both with disease activity and iron deficiency anemia. Controlling inflammation and iron replacement in anemic patients usually leads to a normalization of PLT count. The aim of this review is to update the role of PLT in IBD and present recent data revealing the possible therapeutic implications of anti-PLT agents in future IBD remedies.
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Owczarek D, Cibor D, Głowacki MK, Rodacki T, Mach T. Inflammatory bowel disease: epidemiology, pathology and risk factors for hypercoagulability. World J Gastroenterol 2014; 20:53-63. [PMID: 24415858 PMCID: PMC3886032 DOI: 10.3748/wjg.v20.i1.53] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Revised: 11/19/2013] [Accepted: 12/05/2013] [Indexed: 02/06/2023] Open
Abstract
Hypercoagulability observed in patients with inflammatory bowel diseases (IBD) may lead to thromboembolic events (TE), which affect the venous and arterial systems alike and are an important factor in patients' morbidity and mortality. The risk of TE in IBD patients has been demonstrated to be approximately three-fold higher as compared to the general population. The pathogenesis of thrombosis in IBD patients is multifactorial and not fully explained. The most commonly listed factors include genetic and immune abnormalities, disequilibrium between procoagulant and anticoagulant factors, although recently, the role of endothelial damage as an IBD-triggering factor is underlined. Several studies report that the levels of some coagulation enzymes, including fibrinogen, factors V, VII, VIII, active factor XI, tissue factor, prothrombin fragment 1 + 2 and the thrombin-antithrombin complex, are altered in IBD patients. It has been demonstrated that there is a significant decrease of tissue plasminogen activator level, a marked increase of plasminogen activator inhibitor type 1 and thrombin-activable fibrinolysis inhibitor, a significantly lower level of antithrombin III and tissue factor pathway inhibitor. IBD patients have been also observed to produce an increased amount of various anticoagulant antibodies. Hyperhomocysteinemia, which is a potential risk factor for TE was also observed in some IBD patients. Further studies are necessary to assess the role of coagulation abnormalities in IBD etiology and to determine indications for thromboprophylactic treatment in patients at high risk of developing TE.
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Ra G, Thanabalan R, Ratneswaran S, Nguyen GC. Predictors and safety of venous thromboembolism prophylaxis among hospitalized inflammatory bowel disease patients. J Crohns Colitis 2013; 7:e479-85. [PMID: 23537817 DOI: 10.1016/j.crohns.2013.03.002] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2013] [Accepted: 03/04/2013] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Inflammatory bowel disease (IBD) patients are at increased risk of venous thromboembolism (VTE) especially during hospitalization. We assessed the safety and predictors of VTE prophylaxis in this population. METHODS We conducted a retrospective study of 974 IBD admissions between February 2010 and May 2012. We abstracted data on clinical characteristics, VTE prophylaxis and bleeding events, and conducted multivariate analysis to determine predictors of prophylaxis. RESULTS Pharmacological VTE prophylaxis was administered to 80% of admissions; 63% were within 24h of admission. Patients on the surgical service (adjusted OR [aOR], 3.82; 95% CI: 2.00-7.29) and general medicine (aOR, 2.40; 95% CI: 1.39-4.12) were more likely to receive VTE prophylaxis compared to those on the gastroenterology service. Rectal bleeding on admission was associated with lower prophylaxis (aOR, 0.58; 95% CI: 0.35-0.97). The VTE prophylaxis rate increased from 47% to 73% (P<0.001) on non-surgical services with the introduction of a pharmacist advocate. The rates of major and minor bleeding were similar between patients who did and did not receive VTE prophylaxis (0.26 vs. 0 per 1000 person-days, P=0.7; 4.18 vs. 2.53 per 1000 person-days, P=0.4 respectively), and the major bleeding events (n=2) were post-operative. VTE prophylaxis was not associated with major postoperative bleeding (0.4% vs. 0%, P=0.96). CONCLUSIONS VTE prophylaxis was more frequent on the surgical service, where standardized protocols exist. The introduction of a pharmacist advocate greatly increased VTE prophylaxis on the non-surgical services. Prophylactic anticoagulation is safe in IBD despite the presence of rectal bleeding on admission.
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Affiliation(s)
- Greta Ra
- Mount Sinai Hospital Centre for Inflammatory Bowel Disease, University of Toronto, Toronto, Ontario, Canada
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33
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Kummen M, Schrumpf E, Boberg KM. Liver abnormalities in bowel diseases. Best Pract Res Clin Gastroenterol 2013; 27:531-42. [PMID: 24090940 DOI: 10.1016/j.bpg.2013.06.013] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Accepted: 06/23/2013] [Indexed: 01/31/2023]
Abstract
Liver abnormalities are often seen in bowel diseases. Whether these represent aspects of two separate diseases, or if one is causing the other, is not always easy to decide. Extraintestinal manifestations of inflammatory bowel disease (IBD) or coeliac disease are frequently observed. Of these extraintestinal manifestations, hepatic disorders are among the most common. Primary sclerosing cholangitis (PSC) and primary biliary cirrhosis are the most frequent hepatic disorders in IBD and coeliac disease, respectively. Genetic studies have lately elucidated the associations between IBD and PSC, but there is still a long way until we have complete understanding of the molecular aetiology and pathophysiology of these conditions. There is no curative treatment available for PSC, besides liver transplantation. Steatosis and cholelithiasis are also common in IBD, as are signs of hepatic injury due to IBD treatment. Less common liver abnormalities include liver abscesses, hepatic thromboembolic events, granulomatous liver disease and hepatic amyloidosis.
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Affiliation(s)
- Martin Kummen
- Norwegian PSC Research Center, Division of Cancer Medicine, Surgery and Transplantation, Oslo University Hospital, Rikshospitalet, Pb 4950 Nydalen, N-0424 Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
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Tan VP, Chung A, Yan BP, Gibson PR. Venous and arterial disease in inflammatory bowel disease. J Gastroenterol Hepatol 2013; 28:1095-113. [PMID: 23662785 DOI: 10.1111/jgh.12260] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/26/2013] [Indexed: 12/13/2022]
Abstract
Awareness is increasing that risk of venous thromboembolism and development of atherosclerosis is elevated in patients with some chronic inflammatory diseases. This review aimed to examine the risk of vascular disease in patients with inflammatory bowel disease (IBD) and to identify potential pathogenic mechanisms and therapeutic approaches. An extensive literature search was conducted using MEDLINE database, Cochrane Library and international conference abstracts for studies pertaining to venous and arterial thromboembolism in adult IBD patients. There is a 1.1-3.6 fold risk of venothromboembolism in IBD, affecting 0.55-6.15% of patients. Risks are increased during a flare or with chronically active inflammation. Evidence is building that there may be a modestly increased risk of arterial disease overall, despite evidence that traditional risk factors may be reduced. Multiple pathogenic factors have been identified including endothelial dysfunction, inflammation-mediated calcium deposition in the media of arteries, hyperhomocysteinemia, platelet activation, and altered coagulation and fibrinolysis. The key to active and preventive therapy is to effectively treat inflammation. Recommendations for prophylaxis of venothromboembolism have followed guidelines where they exist and have been extrapolated from studies of other at-risk conditions, as have those for arterial disease, where screening for risk factors and actively treating abnormalities is encouraged. In conclusion, patients with IBD are at considerably increased risk of venothromboembolism and probably of arterial disease, in particular mesenteric ischemia and ischemic heart disease. Increased penetration of gaps between this knowledge and clinical therapeutic action to prevent thromboembolic events into IBD clinical practice is needed.
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Affiliation(s)
- Victoria P Tan
- Department of Medicine, University of Hong Kong, Hong Kong SAR
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Sinagra E, Perricone G, Romano C, Cottone M. Heart failure and anti tumor necrosis factor-alpha in systemic chronic inflammatory diseases. Eur J Intern Med 2013; 24:385-92. [PMID: 23333028 DOI: 10.1016/j.ejim.2012.12.015] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2012] [Revised: 12/10/2012] [Accepted: 12/13/2012] [Indexed: 12/20/2022]
Abstract
Tumor necrosis factor alpha (TNF-alpha) antagonists have emerged as an effective therapy for patients with diseases as Crohn's disease, rheumatoid arthritis, and other chronic systemic inflammatory diseases. In the last years, there has been a growing interest in the role that inflammatory cytokines, which sustain the pathogenesis of these diseases, plays in regulating cardiac structure and function, particularly in the progression of chronic heart failure. In fact there is an increase of anti-TNF alpha levels in advanced heart failure but the treatment with anti-TNF alpha has been shown to worsen the prognosis of heart failure in randomized controlled trials. Patients with rheumatoid arthritis have an increased risk for cardiovascular disease and anti-TNF alpha therapy seems to be beneficial on the risk of cardiovascular disease. In Crohn's disease the increased risk of cardiovascular disease is controversial and therefore it is impossible to demonstrate an effect in reduction of the risk; however, heart failure in patients treated with anti-TNF alpha, despite in a small proportion, has been observed. On the basis of this observation, anti-TNF alpha therapy is contraindicated in patients with Crohn's disease and III-IV New York Heart Association heart failure class.
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Affiliation(s)
- Emanuele Sinagra
- DIBIMIS, Ospedali Riuniti Villa Sofia, Vincenzo Cervello, Division of Internal Medicine, via trabucco 180, Palermo, Italy.
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Venous thrombotic events in hospitalized children and adolescents with inflammatory bowel disease. J Pediatr Gastroenterol Nutr 2013; 56:485-91. [PMID: 23232326 DOI: 10.1097/mpg.0b013e3182801e43] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Adults with inflammatory bowel disease (IBD) have an increased risk of venous thrombotic events (TEs). We sought to evaluate the risk for TE in children and adolescents with IBD using a large population database. METHODS The triennial Healthcare Cost and Utilization Project Kids' Inpatient Database was used in a retrospective cohort study of hospitalized children in the United States across 1997, 2000, 2003, 2006, and 2009. Billing codes were used to identify discharges with Crohn disease, ulcerative colitis, pulmonary embolism, deep vein thrombosis, thrombophlebitis, thrombosis of intracranial venous sinus, Budd-Chiari syndrome, and portal vein thrombosis. A logistic regression model was fitted to quantify the increased risk of TE in children with IBD, while adjusting for other risk factors of thrombosis. RESULTS The total weighted number of pediatric discharges was 7,448,292, and 68,394 (0.92%) were identified with IBD. The incidence of any TE in a hospitalized child or adolescent with IBD was 117.9/10,000 with a relative risk (95% confidence interval) of 2.36 (2.15-2.58). The adjusted odds ratio for any TE in a patient with IBD without surgery was 1.22 (1.08-1.36). Risk factors for TE among patients with IBD include older age, central venous catheter, parenteral nutrition, and an identified hypercoagulable condition. There is an increasing trend of TE in both the IBD and non-IBD patients. CONCLUSIONS Hospitalized children and adolescents with IBD are at increased risk for TE. Conservative methods of TE prevention including hydration, mobilization, or pneumatic devices should be considered in hospitalized patients with IBD.
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Katsanos AH, Katsanos KH, Kosmidou M, Giannopoulos S, Kyritsis AP, Tsianos EV. Cerebral sinus venous thrombosis in inflammatory bowel diseases. QJM 2013; 106:401-13. [PMID: 23243293 DOI: 10.1093/qjmed/hcs229] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND It has been estimated that 1.3-6.4% of patients with inflammatory bowel diseases (IBD) are complicated by cerebral venous thrombosis (CVT) at some point of time during the course of their disease. METHODS We retrospectively reviewed and subsequently analyzed data from 65 case reports of IBD patients with CVT. Our sources included MEDLINE and EMBASE, and the references of retrieved articles were also screened. RESULTS Patients with CVT and IBD were significantly younger than CVT patients without IBD. Female patients were complicated more frequently but at an older age when compared with males. The incidence of ulcerative colitis was almost double compared with Crohn's disease. Active disease was detected in 78.4% of the cases and the proportions of patients with active ulcerative colitis or active Crohn's disease were almost equal. The predominant neurological symptom in these patients was persistent headache (80%) and the most common site of CVT was the superior sagittal sinus (50.7%). Severe iron deficiency anemia was highlighted as a significant risk factor for thrombosis in nearly half of the patients. Transient coagulation abnormalities and hereditary thrombogenic mutations were identified in 23 and 20% of the case reports, respectively. CONCLUSION The overall outcome was very good, especially in those patients who were treated acutely with heparin or low molecular weight heparin, suggesting that heparin administration is related with improved neurological outcome and decreased mortality rates even in IBD patients complicated with CVT.
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Affiliation(s)
- A H Katsanos
- Department of Neurology, University of Ioannina School of Medicine, University Campus, 45110 Ioannina, Greece
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Yuhara H, Steinmaus C, Corley D, Koike J, Igarashi M, Suzuki T, Mine T. Meta-analysis: the risk of venous thromboembolism in patients with inflammatory bowel disease. Aliment Pharmacol Ther 2013; 37:953-62. [PMID: 23550660 DOI: 10.1111/apt.12294] [Citation(s) in RCA: 143] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2012] [Revised: 01/26/2013] [Accepted: 03/11/2013] [Indexed: 12/16/2022]
Abstract
BACKGROUND Inflammatory bowel disease (IBD), which includes Crohn's disease (CD) and ulcerative colitis (UC), is a systemic disorder that predominantly affects the bowels but is also associated with venous thromboembolism (VTE). AIM To provide a quantitative assessment of the association of IBD with venous thromboembolism risk and to explore the possible sources of heterogeneity in the current literature, a meta-analysis of case-control and cohort studies was conducted. METHODS Studies were identified by a literature search of the PubMed and Scopus databases (from inception inclusive 31 December 2012) for English language studies. Summary relative risks (RRs) with 95% confidence intervals (CIs) were calculated with fixed- and random-effects models. Several subgroup analyses were performed to explore potential study heterogeneity and bias. RESULTS Eleven studies met our inclusion criteria. The summary RR for deep venous thromboembolism (DVT) and pulmonary embolism (PE) comparing subjects both with and without IBD was 2.20 (95% CI 1.83-2.65). After adjusting for obesity and smoking, summary relative risks near 2.0 were seen for venous thromboembolism in both UC and CD patients. CONCLUSION This meta-analysis showed that inflammatory bowel disease is associated with an approximately two-fold increase in the risk of venous thromboembolism.
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Affiliation(s)
- H Yuhara
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Tokai University School of Medicine, Isehara, Kanagawa, Japan
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The utility of screening for asymptomatic lower extremity deep venous thrombosis during inflammatory bowel disease flares: a pilot study. Inflamm Bowel Dis 2013; 19:1053-8. [PMID: 23429463 DOI: 10.1097/mib.0b013e3182802a65] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Asymptomatic deep vein thrombosis (DVT) occurs in up to 11% of medical inpatients. The incidence of asymptomatic DVT among patients with inflammatory bowel disease (IBD) is unknown but may be even higher. D-dimer is effective for DVT screening, but its utility has not been studied in the IBD population. METHODS Hospitalized and ambulatory patients with IBD during flares were recruited between 2009 and 2011. Those with clinical symptoms of venous thromboembolism or previous venous thromboembolism were excluded. We determined the prevalence of DVT among asymptomatic subjects using lower extremity Doppler ultrasound and assessed the performance characteristics of the D-dimer in this high-risk study population. RESULTS We enrolled 101 hospitalized and 49 ambulatory patients with IBD during active flares. There were no cases of proximal DVT detected by lower extremity Doppler ultrasound. The 95% confidence interval (CI) for the rate of proximal DVT was 0% to 2%. D-dimer was elevated in 60% of subjects without DVT, occurring more frequently among hospitalized than ambulatory subjects [89% versus 65%, P = 0.01; adjusted odds ratio (aOR), 4.16, 95% CI, 1.58-10.9]. Other predictors of elevated D-dimer were incremental decade in age (aOR, 1.97; 95% CI, 1.24-3.14); ulcerative colitis versus Crohn's disease diagnosis (aOR, 3.38; 95% CI, 1.29-8.84); and every 10-unit increase in C-reactive protein (aOR, 1.33; 95% CI, 1.09-1.62). CONCLUSION From this pilot study, there appears to be low prevalence of asymptomatic DVTs among patients with IBD during flares. The high prevalence of elevated D-dimer in DVT-negative patients limits its utility in IBD.
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Duran R, Denys AL, Letovanec I, Meuli RA, Schmidt S. Multidetector CT features of mesenteric vein thrombosis. Radiographics 2013; 32:1503-22. [PMID: 22977032 DOI: 10.1148/rg.325115100] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Mesenteric vein thrombosis (MVT) accounts for 5%-15% of all mesenteric ischemic events and is classified as either primary or secondary. Primary MVT is idiopathic, whereas secondary MVT can result from a variety of underlying diseases and risk factors, including primary hypercoagulable states or prothrombotic disorders, myeloproliferative neoplasms, cancer (most frequently of the pancreas or liver), diverse inflammatory conditions, recent surgery, portal hypertension, and miscellaneous causes such as oral contraceptives or pregnancy. Clinical symptoms of MVT are rather nonspecific and are mainly characterized by abdominal pain. The mortality rate for MVT remains high, since even now the diagnosis is often delayed. Multidetector computed tomography (CT) is the modality of choice in this context. Although venous bowel ischemia occurs only infrequently with MVT, radiologists should be familiar with its multidetector CT features. Familiarity with the possible causes of MVT, the underlying pathogenic mechanisms associated with MVT, and the correlation between multidetector CT features and these pathogenic mechanisms is necessary to optimize medical management and improve patient care.
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Affiliation(s)
- Rafael Duran
- Department of Diagnostic and Interventional Radiology, Centre Hospitalier Universitaire Vaudois, Rue du Bugnon 46, 1011 Lausanne, Switzerland
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Jones PD, Moll S, Dellon ES. Pulmonary embolism in a patient with eosinophilic esophagitis: causal or coincidental? Case Rep Gastroenterol 2013; 7:82-8. [PMID: 23626508 PMCID: PMC3617889 DOI: 10.1159/000350187] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Eosinophilic esophagitis is a chronic immune-mediated disease characterized by infiltration of the esophageal mucosa with eosinophils and concomitant esophageal dysfunction. Though there are well-described associations between certain chronic inflammatory conditions and venous thromboembolism, there have been no reports of venous thromboembolism occurring in eosinophilic esophagitis. We report the case of a 33-year-old man with severe eosinophilic esophagitis resulting in recurrent esophageal strictures who was unresponsive to oral viscous budesonide therapy, and who developed an isolated pulmonary embolism in the absence of risk factors for venous thromboembolism. We then discuss potential mechanisms for venous thromboembolism in eosinophilic esophagitis, such as inflammation-mediated hypercoagulability, hypereosinophilia, and immunoglobulin E-mediated platelet activation.
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Affiliation(s)
- Patricia D Jones
- Center for Esophageal Diseases and Swallowing, University of North Carolina School of Medicine, Chapel Hill, N.C., USA ; Center for Gastrointestinal Biology and Disease, Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, N.C., USA
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A survey of current practice of venous thromboembolism prophylaxis in hospitalized inflammatory bowel disease patients in the United States. J Clin Gastroenterol 2013; 47:e1-6. [PMID: 22476043 DOI: 10.1097/mcg.0b013e31824c0dea] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Inflammatory bowel disease (IBD) patients are at an increased risk of thrombosis, particularly when hospitalized. Several clinical practice guidelines now recommend pharmacologic prophylaxis for hospitalized ulcerative colitis and Crohn's disease patients. It is unclear to what extent gastroenterologists are aware of these recommendations and whether they are administering pharmacologic venous thromboembolism (VTE) prophylaxis appropriately. Our aim was to explore current practice of VTE prophylaxis in hospitalized IBD patients in the United States. METHODS A survey was mailed electronically to gastroenterologists whose electronic mail address was listed in the American College of Gastroenterology (ACG) database. This survey included clinical vignettes outlining scenarios for consideration of VTE prophylaxis. RESULTS A total of 6227 surveys were sent to gastroenterologists nationwide, and 591 physicians chose to participate (response rate 9.5%). Respondents (80.6%) believed that hospitalized IBD patients have a higher risk of VTE than other inpatients. A total of 29.1% were unaware of any recommendations addressing pharmacologic prophylaxis included in ACG IBD guidelines and 34.6% would give pharmacologic VTE prophylaxis to a hospitalized patient with severe ulcerative colitis. Heparin VTE prophylaxis use was associated with gastroenterologists who indicated that their practices comprised more than 50% of patients with IBD (P=0.0001), being a physician at an academic hospital (P=0.0001) and providers having less than 5 years practice experience (P=0.003). CONCLUSIONS Despite reasonable awareness of the increased risk of thrombosis in hospitalized IBD patients, many US gastroenterologists may not follow clinical practice guidelines and use pharmacologic VTE prophylaxis.
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The role of portal vein thrombosis in the clinical course of inflammatory bowel diseases: report on three cases and review of the literature. Gastroenterol Res Pract 2012; 2012:916428. [PMID: 23093957 PMCID: PMC3475311 DOI: 10.1155/2012/916428] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2012] [Accepted: 09/01/2012] [Indexed: 12/13/2022] Open
Abstract
Inflammatory bowel diseases are associated with an increased risk of vascular complications. The most important are arterial and venous thromboembolisms, which are considered as specific extraintestinal manifestations of inflammatory bowel diseases. Among venous thromboembolism events, portal vein thrombosis has been described in inflammatory bowel diseases. We report three cases of portal vein thrombosis occurring in patients with active inflammatory bowel disease. In two of them, hepatic abscess was present. Furthermore, we performed a systematic review based on the clinical literature published on this topic.
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Affiliation(s)
- J Thachil
- Department of Haematology, University of Liverpool, Liverpool, UK.
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Risk factors of portal vein thrombosis in Crohn's disease patients. J Gastrointest Surg 2012; 16:1199-203. [PMID: 22456981 DOI: 10.1007/s11605-012-1854-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2011] [Accepted: 02/20/2012] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Patients with inflammatory bowel disease, such as Crohn's disease (CD), suffer from a threefold increase in the risk of venous thromboembolism. Small bowel, segmental bowel, or ileocolonic resection to treat Crohn's disease can lead to rare complications of portal vein thrombosis (PVT), which can lead to further poor health outcomes, such as small bowel ischemia. The study attempts to find different risk factors that may be associated with postoperative complications of PVT in Crohn's disease patients. METHODS In a 1 to 3 case-control study following Institutional Review Board approval, 13 Crohn's disease patients with documented radiological postoperative diagnosis of PVT from 2004 to 2011 and 39 CD patients who did not have postoperative PVT were matched by retrospective chart review for patient demographics, preoperative course and workup, anticoagulant use, and operative procedure. Univariate analysis was performed to draw correlations on risk factors for the development of PVT. RESULTS In the 13 CD patients with PVT, concurrent cancer, liver disease, and dyslipidemia were present in 23.1%, 23.1%, and 15.4% of the population, respectively. Compared to the 39 CD only patients, concurrent cancer, liver disease, and dyslipidemia were present in only 2.6%, 2.6%, and 0% of the population, respectively. Of the CD patients with PVT, 61.5% were on preoperative steroids compared to 28.9% of the CD only patients. PVT development in CD patients is correlated with concurrent cancer (p = 0.016), liver disease (p = 0.016), dyslipidemia (p = 0.012), and preoperative steroid usage (p = 0.036). CONCLUSIONS Concurrent cancer, liver disease, dyslipidemia, and preoperative steroid usage were risk factors associated with the development of PVT in Crohn's patients. Since there is limited literature on PVT in CD, more data needs to be collected, and additional studies should be done to further assess the prevention, diagnosis, and management of the disease.
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Marsden L, Cox A, Makris M, Daly ME. Lack of association between polymorphisms in the interleukin-1 gene cluster and familial thrombophilia. Thromb Res 2012; 129:629-34. [DOI: 10.1016/j.thromres.2011.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2011] [Revised: 05/31/2011] [Accepted: 07/05/2011] [Indexed: 10/17/2022]
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Niu GC, Liu L, Zhang XL. Hepatobiliary complications of inflammatory bowel disease. Shijie Huaren Xiaohua Zazhi 2012; 20:662-669. [DOI: 10.11569/wcjd.v20.i8.662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Inflammatory bowel disease (IBD) is a chronic idiopathic immune-mediated inflammatory disease of the gastrointestinal tract, including ulcerative colitis (UC) and Crohn's disease (CD). Extraintestinal manifestations (EIMs) are frequently encountered in IBD patients. Hepatobiliary manifestations are common extraintestinal manifestations of IBD, including primary sclerosing cholangitis (PSC), nonalcoholic fatty liver, cholelithiasis, primary biliary cirrhosis (PBC), small-duct PSC, IgG4-associated cholangitis (IAC), granulomatous hepatitis, amyloidosis, autoimmune hepatitis (AIH), PSC/AIH overlap syndrome, and portal vein thrombosis. In this paper, we describe the progress in understanding the hepatobiliary complications associated with IBD.
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Liver disorders in inflammatory bowel disease. Gastroenterol Res Pract 2012; 2012:642923. [PMID: 22474447 PMCID: PMC3296398 DOI: 10.1155/2012/642923] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2011] [Accepted: 11/30/2011] [Indexed: 02/07/2023] Open
Abstract
Disorders of the hepatobiliary system are relatively common extraintestinal manifestations of inflammatory bowel disease (IBD). These disorders are sometimes due to a shared pathogenesis with IBD as seen in primary sclerosing cholangitis (PSC) and small-duct primary sclerosing cholangitis (small-duct PSC). There are also hepatobiliary manifestations such as cholelithiasis and portal vein thrombosis that occur due to the effects of chronic inflammation and the severity of bowel disease. Lastly, medications used in IBD such as sulfasalazine, thiopurines, and methotrexate can adversely affect the liver. It is important to be cognizant of these disorders as some do have serious long-term consequences. The management of these disorders often requires the expertise of multidisciplinary teams to achieve the best outcomes.
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Tabibian JH, Streiff MB. Inflammatory bowel disease-associated thromboembolism: a systematic review of outcomes with anticoagulation versus catheter-directed thrombolysis. Inflamm Bowel Dis 2012; 18:161-71. [PMID: 21805543 DOI: 10.1002/ibd.21307] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2010] [Accepted: 03/03/2010] [Indexed: 01/08/2023]
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.
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Affiliation(s)
- James H Tabibian
- Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland, USA.
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Benjilali L, Aidi S, El Mansouri H, Benabdejlil M, Jiddane M, El Alaoui Faris M. Cerebral Thrombosis Complicating Crohn's Disease: Two Cases. J Stroke Cerebrovasc Dis 2011; 20:565-9. [DOI: 10.1016/j.jstrokecerebrovasdis.2010.02.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2009] [Revised: 01/16/2010] [Accepted: 02/05/2010] [Indexed: 01/06/2023] Open
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