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Meta-analysis indicates potential link between IBD, VTE
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Patients with inflammatory bowel disease may be at increased risk for developing venous thromboembolism, according to recent study data.
Researchers performed a meta-analysis of 11 studies assessing the association between Crohn’s disease (CD) and/or ulcerative colitis (UC) and incidence of venous thromboembolism (VTE). Studies were collected via the PubMed and Scopus databases, and included one case-control and 10 cohort studies assessing patients aged older than 20 years.
Across all studies, researchers calculated a summary RR of 2.2 (95% CI, 1.83-2.65) for deep vein thrombosis (DVT) or pulmonary embolism (PE) among those with IBD compared with those without IBD. Heterogeneity was observed (I2=95.9%; P<.01); sensitivity analysis that eliminated the study contributing most to this heterogeneity slightly increased the summary RR (2.53; 95% CI, 1.79-3.58), but heterogeneity remained significant.
The association between DVT and IBD was significant in subgroup analysis (RR=1.8; 95% CI, 1.11-2.91 across four studies), but the association between IBD and PE was not (RR=1.63; 95% CI, 0.98-2.72 across four studies). Patients with UC were at similarly increased risk for VTE to those with CD (RR=2.57; 95% CI, 2.02-3.28 across six studies for UC; RR=2.12; 95% CI, 1.4-3.2 across five studies for CD). Adjustment for BMI and tobacco use did not significantly alter the association between IBD and VTE (RR=2.2; 95% CI, 1.83-2.65 across three studies).
Investigators attributed the heterogeneity to factors including varied anatomical location of IBD, misclassification due to the difficulty of diagnosing VTE and the varying study types, populations and settings. Evidence of publication bias was observed (P=.02), but rendered nonsignificant after excluding five studies indicated by Begg funnel plot analysis to be the source of that bias (P=.16).
“This study provides evidence of an association between IBD and VTE, and this evidence should be considered in practice guidelines,” the researchers concluded. “Future studies involving evaluations of the possible diagnostic bias … as well as randomized trials evaluating the risks and benefits of both VTE screening and prophylaxis in patients with IBD, could add further clarity to the discussion.”
Perspective
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Harry S. Jacob, MD, FRCPath(Hon)
This is not new data but it is worth emphasizing, especially for ER doctors who regularly assess pulmonary embolism risk in patients with dyspnea, chest pain, syncope and the like. Some popular guidelines for assessing PE risk do not mention inflammatory bowel disease, while others do. Note the dilemma posed by the dyspneic IBD patient with hemoccult-positive stools yet EKG evidence of right heart strain: To anticoagulate or not, while obtaining definitive workup, can require Solomonic decision-making.
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