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Venous thromboembolism and underutilisation of anticoagulant thromboprophylaxis in hospitalised patients with inflammatory bowel disease
Author(s) -
Dwyer J. P.,
Javed A.,
Hair C. S.,
Moore G. T.
Publication year - 2014
Publication title -
internal medicine journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.596
H-Index - 70
eISSN - 1445-5994
pISSN - 1444-0903
DOI - 10.1111/imj.12488
Subject(s) - medicine , inflammatory bowel disease , medical prescription , venous thromboembolism , ulcerative colitis , medical record , complication , disease , anticoagulant , diagnosis code , pulmonary embolism , intensive care medicine , thrombosis , population , pharmacology , environmental health
Abstract Background Venous thromboembolism ( VTE ) is a well‐recognised extra‐intestinal manifestation of inflammatory bowel disease ( IBD ). Despite the widespread support for anticoagulant prophylaxis in hospitalised IBD patients, the utilisation and efficacy in clinical practice are unknown. Aims The aim of this study was to assess the prevalence and clinical features of VTE among hospitalised IBD patients and ascertain whether appropriate thromboprophylaxis had been administered. Methods All patients with a discharge diagnosis of C rohn disease or ulcerative colitis and VTE were retrospectively identified using International Classification of Diseases, tenth revision codes from medical records at our institution from J uly 1998 to D ecember 2009. Medical records were then reviewed for clinical history and utilisation of thromboprophylaxis. Statistical analysis was performed by M ann– W hitney test and either χ 2 tests or F isher's exact tests. Results Twenty‐nine of 3758 (0.8%) IBD admissions suffered VTE , 13 preadmission and 16 during admission. Of these 29 admissions (in 25 patients), 24% required intensive care unit and 10% died. Of the 16 venous thrombotic events that occurred during an admission, eight (50%) did not receive anticoagulant thromboprophylaxis and eight (50%) occurred despite thromboprophylaxis. Most thromboembolism despite prophylaxis occurred post‐intestinal resection ( n = 5, 63%). Conclusion Thromboprophylaxis is underutilised in half of IBD patients suffering VTE . Prescription of thromboprophylaxis for all hospitalised IBD patients, including dual pharmacological and mechanical prophylaxis in postoperative patients, may lead to a reduction in this preventable complication of IBD .