scholarly journals Minor Hematochezia Decreases Use of Venous Thromboembolism Prophylaxis in Patients with Inflammatory Bowel Disease

2019 ◽  
Vol 26 (9) ◽  
pp. 1394-1400 ◽  
Author(s):  
Adam S Faye ◽  
Kenneth W Hung ◽  
Kimberly Cheng ◽  
John W Blackett ◽  
Anna Sophia Mckenney ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Venous Thromboembolism ◽  
Bowel Disease ◽  
Hospitalized Patients ◽  
High Yield ◽  
Thromboembolism Prophylaxis ◽  
Vte Prophylaxis ◽  
Factors Associated ◽  
Increased Risk ◽  
Inflammatory Bowel

Abstract Background Despite increased risk of venous thromboembolism (VTE) among hospitalized patients with inflammatory bowel disease (IBD), pharmacologic prophylaxis rates remain low. We sought to understand the reasons for this by assessing factors associated with VTE prophylaxis in patients with IBD and the safety of its use. Methods This was a retrospective cohort study conducted among patients hospitalized between January 2013 and August 2018. The primary outcome was VTE prophylaxis, and exposures of interest included acute and chronic bleeding. Medical records were parsed electronically for covariables, and logistic regression was used to assess factors associated with VTE prophylaxis. Results There were 22,499 patients studied, including 474 (2%) with IBD. Patients with IBD were less likely to be placed on VTE prophylaxis (79% with IBD, 87% without IBD), particularly if hematochezia was present (57% with hematochezia, 86% without hematochezia). Among patients with IBD, admission to a medical service and hematochezia (adjusted odds ratio 0.27; 95% CI, 0.16–0.46) were among the strongest independent predictors of decreased VTE prophylaxis use. Neither hematochezia nor VTE prophylaxis was associated with increased blood transfusion rates or with a clinically significant decline in hemoglobin level during hospitalization. Conclusion Hospitalized patients are less likely to be placed on VTE prophylaxis if they have IBD, and hematochezia may drive this. Hematochezia appeared to be minor and was unaffected by VTE prophylaxis. Education related to the safety of VTE prophylaxis in the setting of minor hematochezia may be a high-yield way to increase VTE prophylaxis rates in patients with IBD.

Cost-effectiveness of Venous Thromboembolism Prophylaxis After Hospitalization in Patients With Inflammatory Bowel Disease

2021 ◽  
Author(s):  
Kate E Lee ◽  
Francesca Lim ◽  
Jean-Frederic Colombel ◽  
Chin Hur ◽  
Adam S Faye
Keyword(s):  
Inflammatory Bowel Disease ◽  
Venous Thromboembolism ◽  
Cost Effectiveness ◽  
Incremental Cost ◽  
Bowel Disease ◽  
Sensitivity Analyses ◽  
Vte Prophylaxis ◽  
Life Years ◽  
Increased Risk ◽  
Inflammatory Bowel

Abstract Background Patients with inflammatory bowel disease (IBD) have a 2- to 3-fold greater risk of venous thromboembolism (VTE) than patients without IBD, with increased risk during hospitalization that persists postdischarge. We determined the cost-effectiveness of postdischarge VTE prophylaxis among hospitalized patients with IBD. Methods A decision tree compared inpatient prophylaxis alone vs 4 weeks of postdischarge VTE prophylaxis with 10 mg/day of rivaroxaban. Our primary outcome was quality-adjusted life years (QALYs) over 1 year, and strategies were compared using a willingness to pay of $100,000/QALY from a societal perspective. Costs (in 2020 $USD), incremental cost-effectiveness ratios (ICERs) and number needed to treat (NNT) to prevent 1 VTE and VTE death were calculated. Deterministic 1-way and probabilistic analyses assessed model uncertainty. Results Prophylaxis with rivaroxaban resulted in 1.68-higher QALYs per 1000 persons compared with no postdischarge prophylaxis at an incremental cost of $185,778 per QALY. The NNT to prevent a single VTE was 78, whereas the NNT to prevent a single VTE-related death was 3190. One-way sensitivity analyses showed that higher VTE risk >4.5% and decreased cost of rivaroxaban ≤$280 can reduce the ICER to <$100,000/QALY. Probabilistic sensitivity analyses favored prophylaxis in 28.9% of iterations. Conclusions Four weeks of postdischarge VTE prophylaxis results in higher QALYs compared with inpatient prophylaxis alone and prevents 1 postdischarge VTE among 78 patients with IBD. Although postdischarge VTE prophylaxis for all patients with IBD is not cost-effective, it should be considered in a case-by-case scenario, considering VTE risk profile, costs, and patient preference.

scholarly journals Survey of Perceptions and Practices among Canadian Gastroenterologists regarding the Prevention of Venous Thromboembolism for Hospitalized Inflammatory Bowel Disease Patients

2012 ◽  
Vol 26 (11) ◽  
pp. 795-798 ◽  
Author(s):  
Roshan Razik ◽  
Charles N Bernstein ◽  
Justina Sam ◽  
Reka Thanabalan ◽  
Geoffrey C Nguyen
Keyword(s):  
Inflammatory Bowel Disease ◽  
Venous Thromboembolism ◽  
Bowel Disease ◽  
Demographic Data ◽  
Pharmacological Prophylaxis ◽  
Vte Prophylaxis ◽  
Clinical Scenarios ◽  
Increased Risk ◽  
Inflammatory Bowel ◽  
Preventable Complication

BACKGROUND: Patients with inflammatory bowel disease (IBD) who are hospitalized with disease flares are known to be at an increased risk of venous thromboembolism (VTE). This is a preventable complication; however, there is currently no standardized approach to the prevention and management of VTE.OBJECTIVES: To characterize the opinions and general prophylaxis patterns of Canadian gastroenterologists and IBD experts.METHODS: A survey questionnaire was sent to Canadian gastroenterologists affiliated with a medical school or IBD referral centre. Participants were required to be practicing physicians who had completed all of their training and had been involved in the care of IBD patients within the previous 12 months. Various clinical scenarios were presented and demographic data were solicited.RESULTS: The majority of respondents were practicing in an academic setting (95%) and considered themselves to be IBD experts or subspecialists (71%). Eighty-three per cent reported providing VTE prophylaxis most, if not all of the time, and most (96%) used pharmacological prophylaxis alone, usually heparin or one of its analogues. There was less consistency among respondents with respect to whether IBD patients in remission, but admitted for another condition, should be given prophylaxis. There was also less agreement regarding the duration of anticoagulation in patients with confirmed VTE.CONCLUSION: There was a general consensus among academic gastroenterologists that IBD inpatients are at an increased risk for VTE and would benefit from VTE prophylaxis. However, areas of uncertainty still exist and the IBD community would benefit from evidence-based clinical practice guidelines to standardize the management of this important problem.

730 INCREASED RISK OF VENOUS THROMBOEMBOLISM IN PAEDIATRIC-ONSET INFLAMMATORY BOWEL DISEASE - A STUDY OF THE INTERNATIONAL PROSPECTIVE SAFETY REGISTRY

2021 ◽  
Vol 160 (6) ◽  
pp. S-146
Author(s):  
Renz Klomberg ◽  
Martine Aardoom ◽  
Polychronis Kemos ◽  
Frank Ruemmele ◽  
C.H. (Heleen) Van Ommen ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Venous Thromboembolism ◽  
Bowel Disease ◽  
Increased Risk ◽  
Inflammatory Bowel

Hematochezia Decreases Use of Venous Thromboembolism Prophylaxis in Patients With Inflammatory Bowel Disease

2019 ◽  
Vol 157 (1) ◽  
pp. e24-e25
Author(s):  
Adam S. Faye ◽  
Kenneth Hung ◽  
Jon W. Blackett ◽  
Adam R. Pont ◽  
Garrett Lawlor ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Venous Thromboembolism ◽  
Bowel Disease ◽  
Thromboembolism Prophylaxis ◽  
Venous Thromboembolism Prophylaxis ◽  
Inflammatory Bowel

Prevalence and Factors Associated With Fatigue in Patients With Inflammatory Bowel Disease: A Multicentre Study

2019 ◽  
Vol 13 (8) ◽  
pp. 996-1002 ◽  
Author(s):  
C Chavarría ◽  
M J Casanova ◽  
M Chaparro ◽  
M Barreiro-de Acosta ◽  
E Ezquiaga ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Inflammatory Bowel Disease ◽  
Sleep Quality ◽  
Multicentre Study ◽  
Sleep Disorders ◽  
Bowel Disease ◽  
Factors Associated ◽  
Increased Risk ◽  
Inflammatory Bowel

Abstract Background and Aims The aims of this study were to determine the prevalence of fatigue in patients with inflammatory bowel disease [IBD], to identify the factors associated with fatigue and its severity, to assess the impact of fatigue on quality of life [QoL], and to evaluate the relationship between fatigue and sleep disorders. Methods This was a prospective multicentre study conducted at 22 Spanish centres. Consecutive patients followed at IBD Units were included. Fatigue was evaluated with the Fatigue Severity Scale [FSS] and the Fatigue Impact Scale [FIS]. Quality of life and sleep quality were assessed using the IBD Questionnaire-Short Form [IBDQ-9] and the Pittsburgh Sleep Quality Index [PSQI], respectively. Results A total of 544 consecutive adult IBD patients were included [50% women, mean age 44 years, 61% Crohn’s disease]. The prevalence of fatigue was 41% (95% confidence interval [CI] = 37–45%). The variables associated with an increased risk of fatigue were: anxiety [OR = 2.5, 95% CI = 1.6–3.7], depression [OR = 2.4, 95% CI = 1.4–3.8], presence of extraintestinal manifestations [EIMs] [OR = 1.7, 95% CI = 1.1–2.6], and treatment with systemic steroids [OR = 2.8, 95% CI = 1.4–5.7]. The presence of EIMs [regression coefficient, RC = 8.2, 95% CI = 2.3–14.2], anxiety [RC = 25.8, 95% CI = 20.0–31.5], depression [RC = 30.6, 95% CI = 24.3–37.0], and sleep disturbances [RC = 15.0, 95% CI = 9.3–20.8] were associated with severity of fatigue. Patients with fatigue had a significantly decreased IBDQ-9 score [p < 0.001]. Conclusions The prevalence of fatigue in IBD patients is remarkably high and has a negative impact on QoL. Therapy with systemic steroids is associated with an increased risk of fatigue. The severity of fatigue is associated with anxiety, depression, sleep disorders, and the presence of EIMs. Fatigue was not associated with anaemia, disease activity or anti-TNF therapy.

Sign in / Sign up

Export Citation Format

Share Document