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Gastroenterology. 2014 Mar;146(3):835-848.e6. doi: 10.1053/j.gastro.2014.01.042. Epub 2014 Jan 22.

Consensus statements on the risk, prevention, and treatment of venous thromboembolism in inflammatory bowel disease: Canadian Association of Gastroenterology.

Author information

1
Mount Sinai Hospital Centre for Inflammatory Bowel Disease, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada. Electronic address: geoff.nguyen@utoronto.ca.
2
IBD Clinical and Research Centre, University of Manitoba, Winnipeg, Manitoba, Canada.
3
Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada.
4
Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.
5
Division of Gastroenterology, Hepatology, and Nutrition, Sick Kids Hospital, Toronto, Ontario, Canada.
6
Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
7
Thromboembolism Program, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
8
Department of Medicine, Division of Gastroenterology, St Paul's Hospital, Vancouver, British Columbia, Canada.
9
Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada.
10
Clinical Epidemiology Program, The Ottawa Hospital, Ottawa, Ontario, Canada.
11
Division of Gastroenterology, Western University, London, Ontario, Canada.
12
Hamilton Health Sciences Centre, Hamilton, Ontario, Canada.
13
Dalhousie University, Halifax, Nova Scotia; Memorial University, St John's, Newfoundland, Canada.

Abstract

BACKGROUND & AIMS:

Guidelines for the management of venous thromboembolism (VTE) from the American College of Chest Physicians do not address patients with inflammatory bowel disease (IBD), a group with a high risk of both VTE and gastrointestinal bleeding. We present recommendations for the prevention and treatment of VTE in patients with IBD.

METHODS:

A systematic literature search was performed to identify studies on VTE in IBD. The quality of evidence and strength of recommendations were rated according to the Grading of Recommendation Assessment, Development, and Evaluation (GRADE) approach. Statements were developed through an iterative online platform, then finalized and voted on by a working group of adult and pediatric gastroenterologists and thrombosis specialists.

RESULTS:

IBD patients have an approximately 3-fold higher risk of VTE compared with individuals without IBD, and disease flares further increase this risk. Anticoagulant thromboprophylaxis is recommended for IBD patients who are hospitalized with IBD flares without active bleeding and is suggested when bleeding is nonsevere. Anticoagulant thromboprophylaxis is suggested during moderate-severe IBD flares in outpatients with a history of VTE provoked by an IBD flare or an unprovoked VTE, but not otherwise. The recommended duration of anticoagulation after a first VTE is based on the presence of provoking factors. Specific suggestions are made for the prevention and treatment of VTE in pediatric and pregnant IBD patients.

CONCLUSIONS:

Using the American College of Chest Physicians' guidelines as a foundation, we have integrated evidence from IBD studies to develop specific recommendations for the management of VTE in this high-risk population.

KEYWORDS:

Anticoagulant Therapy; Crohn’s Disease; Inflammatory Bowel Disease; Ulcerative Colitis; Venous Thromboembolism

PMID:
24462530
DOI:
10.1053/j.gastro.2014.01.042
[Indexed for MEDLINE]
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