Hospitalized patients with IBD have a threefold increased risk of venous thromboembolism (VTE), for which current treatment guidelines recommend routine pharmacologic prophylaxis. Recent studies suggest that risk of VTE persists in the early post-discharge period; however, routine extended prophylaxis is not recommended. The aims of the current study were to assess the incidence and risk factors for post-discharge VTE and create a risk stratification tool to guide prophylaxis. At a large, tertiary hospital, the authors retrospectively reviewed the hospital records of 2161 IBD patients and determined the incidence of major VTE within 6 months post-discharge.
During hospitalization, anticoagulation was administered to 70.6% (1525/2161; 4.5% therapeutic; 66.1% prophylaxis). Post-discharge, 4.4% (95/2161) received extended prophylaxis. During 6-month post-discharge follow-up, 48 symptomatic VTE events occurred (2.2%; median time to VTE of 37 days; range 3-182). On multivariate analysis, risk of post-discharge VTE was associated with age >45 years (OR 3.76; CI: 1.80-7.89) and need for multiple admissions (OR 2.42; CI: 1.23-4.66). Interestingly, need for corticosteroids and intestinal surgery were not associated with increased VTE risk. A prediction model was developed that included patient age, length of stay, ICU admission, need for readmission, and need for central venous line. Using this model, a high-risk group (8.3%; 179/2161) was identified that had an 8.4% risk (15/179) of post-discharge VTE compared with a low-risk group with only a 0.7% risk (7/1028).
Clinicians need to be aware that a subset of hospitalized IBD patients are at increased risk of post-discharge VTE, especially those with multiple admissions or age >45 years. Further work is needed to identify the risk factors for post-discharge VTE and to validate clinical decision tools that will optimize appropriate application of extended prophylaxis.
McCurdy JD, Israel A, Hasan M, et al. A clinical predictive model for post-hospitalisation venous thromboembolism in patients with inflammatory bowel disease. Aliment Pharmacol Ther