warfarin and Inflammatory-Bowel-Diseases

Portal vein thrombosis (PVT) is a poorly described complication of inflammatory bowel disease (IBD). We sought to better characterize presentations, compare treatments, and assess outcomes in IBD-related PVT.. We conducted a retrospective investigation of IBD-related PVT at our institution. Multivariable Cox proportional hazards modeling was used to estimate adjusted hazard ratios across treatments.. Sixty-three patients with IBD-related PVT (26 with Crohn disease, 37 with ulcerative colitis) were followed for a median 21 months (interquartile ratio [IQR] = 9-52). Major risk factors included intra-abdominal surgery (60%), IBD flare (33%), and intra-abdominal infection (13%). Primary hematologic thrombophilias were rare and did not impact management. Presentations were generally nonspecific, and diagnosis was incidental. Ninety-two percent of patients (58/63) received anticoagulation (AC), including 23 who received direct oral anticoagulants (DOACs), 22 who received warfarin, and 13 who received enoxaparin. All anticoagulated patients started AC within 3 days of diagnosis. Complete radiographic resolution (CRR) of PVT occurred in 71% of patients. We found that DOACs were associated with higher CRR rates (22/23; 96%) relative to warfarin (12/22; 55%): the hazard ratio of DOACs to warfarin was 4.04 (1.83-8.93; P = 0.0006)). Patients receiving DOACs required shorter courses of AC (median 3.9 months; IQR = 2.7-6.1) than those receiving warfarin (median 8.5 months; IQR = 3.9-NA; P = 0.0190). Incidence of gut ischemia (n = 3), symptomatic portal hypertension (n = 3), major bleeding (n = 4), and death (n = 2) were rare, and no patients receiving DOACs experienced these adverse outcomes.. We show that early and aggressive use of AC can lead to excellent outcomes in IBD-associated PVT and that DOACs are associated with particularly favorable outcomes in this setting.

Topics: Anticoagulants; Humans; Inflammatory Bowel Diseases; Portal Vein; Retrospective Studies; Venous Thrombosis; Warfarin

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.. 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.. 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).. 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.

Topics: Adult; Anticoagulants; Contraindications; Female; Fondaparinux; Gastrointestinal Hemorrhage; Heparin, Low-Molecular-Weight; Hospital Departments; Hospitalization; Humans; Inflammatory Bowel Diseases; Male; Middle Aged; Pharmacy Service, Hospital; Polysaccharides; Practice Patterns, Physicians'; Rectum; Retrospective Studies; Venous Thromboembolism; Warfarin; Young Adult

Thromboembolic events are well recognised in patients with inflammatory bowel disease (IBD). We present three cases which highlight the need for vigilance with respect to this complication. We also propose that consideration be given to re-evaluating disease activity in those patients who develop thromboembolic complications.

Topics: Adult; Anticoagulants; Female; Heparin, Low-Molecular-Weight; Humans; Inflammation; Inflammatory Bowel Diseases; Leg; Male; Middle Aged; Risk Factors; Smoking; Thrombectomy; Thromboembolism; Tinzaparin; Treatment Outcome; Warfarin

Topics: Adult; Anti-Inflammatory Agents, Non-Steroidal; Anticoagulants; Hematoma; Hematuria; Heparin, Low-Molecular-Weight; Humans; Immunosuppressive Agents; Inflammatory Bowel Diseases; Male; Mesalamine; Prednisolone; Pulmonary Embolism; Urinary Bladder Diseases; Warfarin

Cerebral venous thrombosis is an uncommon and diverse entity accounting for less than 1% of strokes. It can present with a variety of clinical symptoms ranging from isolated headaches to deep coma making the clinical diagnosis difficult. We present a rare case of cerebral venous thrombosis secondary to dehydration and inflammatory bowel disease.

Topics: Anticoagulants; Dehydration; Heparin; Humans; Inflammatory Bowel Diseases; Intracranial Thrombosis; Male; Middle Aged; Risk Factors; Stroke; Venous Thrombosis; Warfarin

Topics: Adult; Anticoagulants; Antithrombin III; Antithrombin III Deficiency; Autoimmune Diseases; Humans; Inflammatory Bowel Diseases; Intracranial Thrombosis; Magnetic Resonance Imaging; Male; Warfarin

Topics: Adenocarcinoma; Adult; Anticoagulants; Arterial Occlusive Diseases; Autoimmune Diseases; Drug Resistance; Female; Heparin; Heparin, Low-Molecular-Weight; Hepatitis C, Chronic; Hirudins; Humans; Inflammatory Bowel Diseases; Male; Middle Aged; Neoplasms, Unknown Primary; Platelet Aggregation Inhibitors; Portal Vein; Pulmonary Embolism; Recombinant Proteins; Recurrence; Thrombocytopenia; Vena Cava, Inferior; Venous Thrombosis; Warfarin

Topics: Abdomen; Adolescent; Anticoagulants; Antitubercular Agents; Diagnosis, Differential; Female; Femoral Vein; Heparin; Humans; Inflammatory Bowel Diseases; Leg; Tuberculosis, Gastrointestinal; Ultrasonography; Venous Thrombosis; Warfarin

Topics: Anticoagulants; Antithrombin III; Colitis, Ulcerative; Heparin; Humans; Inflammatory Bowel Diseases; Warfarin