Treatment of thromboembolism in IBD: More questions than answers

Venous thromboembolism (VTE) is a well-established complication of inflammatory bowel disease (IBD). IBD patients are at 3–4-fold higher risk of VTE compared to the general population, with lifetime cumulative risks approaching 30% by age 70 years.1,2 The mortality following VTE in the IBD population has been reported to be as high as 22%.3,4 Thus, a high index of suspicion and prompt treatment are critical in optimizing health outcomes following VTE. As in the general population, the mainstay of VTE treatment in those with IBD is anticoagulation therapy and, in select patients, use of thrombolytics. Because IBD patients frequently have active disease with gastrointestinal bleeding, there may be concerns regarding the safety of anticoagulation therapy. A meta-analysis of studies in which anticoagulation was used as primary treatment for IBD did not show increased risk of major bleeding.5 However, there remains a paucity of efficacy and safety data for treatment of VTE in the IBD population.