Thromboprophylaxis Is Associated With Reduced Post-hospitalization Venous Thromboembolic Events in Patients With Inflammatory Bowel Diseases

被引：55

作者：

Ananthakrishnan, Ashwin N. ^{[1
,4
]}

Cagan, Andrew ^{[5
]}

Gainer, Vivian S. ^{[5
]}

Cheng, Su-Chun ^{[6
]}

Cai, Tianxi ^{[6
]}

Scoville, Elizabeth ^{[1
]}

Konijeti, Gauree G. ^{[1
]}

Szolovits, Peter ^{[7
]}

Shaw, Stanley Y. ^{[2
,4
]}

Churchill, Susanne ^{[8
]}

Karlson, Elizabeth W. ^{[4
,9
]}

Murphy, Shawn N. ^{[3
,4
,5
]}

Kohane, Isaac ^{[4
,8
,10
]}

Liao, Katherine P. ^{[4
,9
]}

机构：

[1] Massachusetts Gen Hosp, Div Gastroenterol, Boston, MA 02114 USA

[2] Massachusetts Gen Hosp, Ctr Syst Biol, Boston, MA 02114 USA

[3] Massachusetts Gen Hosp, Dept Neurol, Boston, MA 02114 USA

[4] Harvard Univ, Sch Med, Boston, MA USA

[5] Partners HealthCare, Res IS & Comp, Charlestown, MA USA

[6] Harvard Univ, Sch Publ Hlth, Dept Biostat, Boston, MA 02115 USA

[7] MIT, Cambridge, MA 02139 USA

[8] Brigham & Womens Hosp, Natl Ctr Biomed Comp i2b2, Boston, MA 02115 USA

[9] Brigham & Womens Hosp, Div Rheumatol Allergy & Immunol, Boston, MA 02115 USA

[10] Childrens Hosp, Boston, MA 02115 USA

来源：

CLINICAL GASTROENTEROLOGY AND HEPATOLOGY | 2014年 / 12卷 / 11期

基金：

美国国家卫生研究院;

关键词：

CD; UC; Clot; Vein; Vascular; RISK-FACTORS; PULMONARY-EMBOLISM; CO-MORBIDITY; THROMBOSIS; PROPHYLAXIS; CANCER; GLUCOCORTICOIDS; SURGERY; HEPARIN; FLARES;

D O I：

10.1016/j.cgh.2014.02.034

中图分类号：

R57 [消化系及腹部疾病];

学科分类号：

摘要：

BACKGROUND & AIMS: Patients with inflammatory bowel diseases (IBDs) have increased risk for venous thromboembolism (VTE); those who require hospitalization have particularly high risk. Few hospitalized patients with IBD receive thromboprophylaxis. We analyzed the frequency of VTE after IBD-related hospitalization, risk factors for post-hospitalization VTE, and the efficacy of prophylaxis in preventing post-hospitalization VTE. METHODS: In a retrospective study, we analyzed data from a multi-institutional cohort of patients with Crohn's disease or ulcerative colitis and at least 1 IBD-related hospitalization. Our primary outcome was a VTE event. All patients contributed person-time from the date of the index hospitalization to development of VTE, subsequent hospitalization, or end of follow-up. Our main predictor variable was pharmacologic thromboprophylaxis. Cox proportional hazard models adjusting for potential confounders were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). RESULTS: From a cohort of 2788 patients with at least 1 IBD-related hospitalization, 62 patients developed VTE after discharge (2%). Incidences of VTE at 30, 60, 90, and 180 days after the index hospitalization were 3.7/1000, 4.1/1000, 5.4/1000, and 9.4/1000 person-days, respectively. Pharmacologic thromboprophylaxis during the index hospital stay was associated with a significantly lower risk of post-hospitalization VTE (HR, 0.46; 95% CI, 0.22-0.97). Increased numbers of comorbidities (HR, 1.30; 95% CI, 1.16-1.47) and need for corticosteroids before hospitalization (HR, 1.71; 95% CI, 1.02-2.87) were also independently associated with risk of VTE. Length of hospitalization or surgery during index hospitalization was not associated with post-hospitalization VTE. CONCLUSIONS: Pharmacologic thromboprophylaxis during IBD-related hospitalization is associated with reduced risk of post-hospitalization VTE.

引用

页码：1905 / 1910

页数：6

共 35 条

[1] Psychiatric co-morbidity is associated with increased risk of surgery in Crohn's disease [J].

Ananthakrishnan, A. N. ;

Gainer, V. S. ;

Perez, R. G. ;

Cai, T. ;

Cheng, S-C. ;

Savova, G. ;

Chen, P. ;

Szolovits, P. ;

Xia, Z. ;

De Jager, P. L. ;

Shaw, S. Y. ;

Churchill, S. ;

Karlson, E. W. ;

Kohane, I. ;

Perlis, R. H. ;

Plenge, R. M. ;

Murphy, S. N. ;

Liao, K. P. .

ALIMENTARY PHARMACOLOGY & THERAPEUTICS, 2013, 37 (04) :445-454

[2] Normalization of Plasma 25-Hydroxy Vitamin D Is Associated with Reduced Risk of Surgery in Crohn's Disease [J].

Ananthakrishnan, Ashwin N. ;

Cagan, Andrew ;

Gainer, Vivian S. ;

Cai, Tianxi ;

Cheng, Su-Chun ;

Savova, Guergana ;

Chen, Pei ;

Szolovits, Peter ;

Xia, Zongqi ;

De Jager, Philip L. ;

Shaw, Stanley Y. ;

Churchill, Susanne ;

Karlson, Elizabeth W. ;

Kohane, Isaac ;

Plenge, Robert M. ;

Murphy, Shawn N. ;

Liao, Katherine P. .

INFLAMMATORY BOWEL DISEASES, 2013, 19 (09) :1921-1927

[3] Improving Case Definition of Crohn's Disease and Ulcerative Colitis in Electronic Medical Records Using Natural Language Processing: A Novel Informatics Approach [J].

Ananthakrishnan, Ashwin N. ;

Cai, Tianxi ;

Savova, Guergana ;

Cheng, Su-Chun ;

Chen, Pei ;

Perez, Raul Guzman ;

Gainer, Vivian S. ;

Murphy, Shawn N. ;

Szolovits, Peter ;

Xia, Zongqi ;

Shaw, Stanley ;

Churchill, Susanne ;

Karlson, Elizabeth W. ;

Kohane, Isaac ;

Plenge, Robert M. ;

Liao, Katherine P. .

INFLAMMATORY BOWEL DISEASES, 2013, 19 (07) :1411-1420

[4] Randomized comparison of unfractionated heparin with corticosteroids in severe active inflammatory bowel disease [J].

Ang, YS ;

Mahmud, N ;

White, B ;

Byrne, M ;

Kelly, A ;

Lawler, M ;

McDonald, GSA ;

Smith, OP ;

Keeling, PWN .

ALIMENTARY PHARMACOLOGY & THERAPEUTICS, 2000, 14 (08) :1015-1022

[5]

Bernstein CN, 2001, THROMB HAEMOSTASIS, V85, P430

[6] Thrombosis in inflammatory bowel disease: Are we tailoring prophylaxis to those most at risk? [J].

Bryant, Robert V. ;

Jairath, Vipul ;

Curry, Nicola ;

Travis, Simon P. L. .

JOURNAL OF CROHNS & COLITIS, 2014, 8 (02) :166-171

[7] A NEW METHOD OF CLASSIFYING PROGNOSTIC CO-MORBIDITY IN LONGITUDINAL-STUDIES - DEVELOPMENT AND VALIDATION [J].

CHARLSON, ME ;

POMPEI, P ;

ALES, KL ;

MACKENZIE, CR .

JOURNAL OF CHRONIC DISEASES, 1987, 40 (05) :373-383

[8] Timing and Perioperative Risk Factors for In-Hospital and Post-Discharge Venous Thromboembolism After Colorectal Cancer Resection [J].

Davenport, Daniel L. ;

Vargas, H. David ;

Kasten, Michael W. ;

Xenos, Eleftherios S. .

CLINICAL AND APPLIED THROMBOSIS-HEMOSTASIS, 2012, 18 (06) :569-575

[9] Prevention of VTE in Orthopedic Surgery Patients Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines [J].

Falck-Ytter, Yngve ;

Francis, Charles W. ;

Johanson, Norman A. ;

Curley, Catherine ;

Dahl, Ola E. ;

Schulman, Sam ;

Ortel, Thomas L. ;

Pauker, Stephen G. ;

Colwell, Clifford W., Jr. .

CHEST, 2012, 141 (02) :E278S-E325S

[10] Venous Thromboembolism Prophylaxis for Medical Service-Mostly Cancer-Patients at Hospital Discharge [J].

Fanikos, John ;

Rao, Amanda ;

Seger, Andrew C. ;

Piazza, Gregory ;

Catapane, Elaine ;

Chen, Xiaohua ;

Goldhaber, Samuel Z. .

AMERICAN JOURNAL OF MEDICINE, 2011, 124 (12) :1143-1150

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