Prevention of Venous Thromboembolism in Patients with Inflammatory Bowel Disease

Authors

  • Michal Gozdzik, MD Division of Gastroenterology, Department of Medicine, University of Alberta

DOI:

https://doi.org/10.58931/cibdt.2025.3247

Abstract

Key Takeaways:

•  When reviewing inflammatory bowel disease (IBD) patients in the clinical setting, remember to review their medical history and screen for venous thromboembolism (VTE) risk factors. This will help to risk stratify them for future decision-making.

•  IBD patients admitted to hospital are at the highest risk of VTE. All IBD patients, regardless of reason for admission and disease activity, should receive VTE prophylaxis.

•  In the post-operative and post-discharge setting, all IBD patients should be classified as low, intermediate, or high risk of VTE. After carefully weighing the risks and benefits, high risk patients should be considered for extended VTE prophylaxis beyond hospital discharge.

Author Biography

Michal Gozdzik, MD, Division of Gastroenterology, Department of Medicine, University of Alberta

Dr. Michal Gozdzik is a gastroenterologist and Assistant Professor of Medicine at the University of Alberta. He completed Internal Medicine at the University of Saskatchewan followed by Gastroenterology at the University of Ottawa, and an Advanced Inflammatory Bowel Disease Fellowship at the University of Alberta. Following this he completed additional intestinal ultrasound training at the University of Calgary, University of Saskatchewan, and the Policlinico Tor Vergata Hospital in Rome, Italy. His clinical and academic interests focus on inflammatory bowel disease, intestinal ultrasound, and medical education.

References

Wendelboe A, Weitz JI. Global health burden of venous thromboembolism. Arterioscler Thromb Vasc Biol. 2024;44(5):1007-1011. doi:10.1161/ATVBAHA.124.320151 DOI: https://doi.org/10.1161/ATVBAHA.124.320151

Danese S, Papa A, Saibeni S, Repici A, Malesci A, Vecchi M. Inflammation and coagulation in inflammatory bowel disease: the clot thickens. Am J Gastroenterol. 2007;102(1):174-186. doi:10.1111/j.1572-0241.2006.00943.x DOI: https://doi.org/10.1111/j.1572-0241.2006.00943.x

Gozdzik M, Unninayar D, Siegal DM, Sarker AK, Kim E, Murthy S, et al. Risk factors for venous thromboembolism in inflammatory bowel disease: a systematic review and meta-analysis by phase of care. Inflamm Bowel Dis. Published online May 9, 2025. doi:10.1093/ibd/izaf078 DOI: https://doi.org/10.1093/ibd/izaf078

Bernstein CN, Blanchard JF, Houston DS, Wajda A. The incidence of deep venous thrombosis and pulmonary embolism among patients with inflammatory bowel disease: a population-based cohort study. Thromb Haemost. 2001;85(3):430-434. DOI: https://doi.org/10.1055/s-0037-1615600

Grainge MJ, West J, Card TR. Venous thromboembolism during active disease and remission in inflammatory bowel disease: a cohort study. Lancet. 2010;375(9715):657-663. doi:10.1016/S0140-6736(09)61963-2 DOI: https://doi.org/10.1016/S0140-6736(09)61963-2

McCurdy JD, Israel A, Hasan M, Weng R, Mallick R, Ramsay T, et al. A clinical predictive model for post‐hospitalisation venous thromboembolism in patients with inflammatory bowel disease. Aliment Pharmacol Ther. 2019;49(12):1493-1501. doi:10.1111/apt.15286 DOI: https://doi.org/10.1111/apt.15286

Murthy SK, McCurdy AB, Carrier M, McCurdy JD. Venous thromboembolic events in inflammatory bowel diseases: a review of current evidence and guidance on risk in the post-hospitalization setting. Thromb Res. 2020;194:26-32. doi:10.1016/j.thromres.2020.06.005 DOI: https://doi.org/10.1016/j.thromres.2020.06.005

Nguyen GC, Bernstein CN, Bitton A, Chan AK, Griffiths AM, Leontiadis GI, et al. Consensus statements on the risk, prevention, and treatment of venous thromboembolism in inflammatory bowel disease: Canadian Association of Gastroenterology. Gastroenterology. 2014;146(3):835-848.e6. doi:10.1053/j.gastro.2014.01.042 DOI: https://doi.org/10.1053/j.gastro.2014.01.042

Olivera PA, Zuily S, Kotze PG, Regnault V, Al Awadhi S, Bossuyt P, et al. International consensus on the prevention of venous and arterial thrombotic events in patients with inflammatory bowel disease. Nat Rev Gastroenterol Hepatol. 2021;18(12):857-873. doi:10.1038/s41575-021-00492-8 DOI: https://doi.org/10.1038/s41575-021-00492-8

Kahn SR, Lim W, Dunn AS, Cushman M, Dentali F, Akl EA, et al. Prevention of VTE in nonsurgical patients: antithrombotic therapy and prevention of thrombosis: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012;141(2 Suppl):e195S-e226S. doi:10.1378/chest.11-2296 DOI: https://doi.org/10.1378/chest.11-2296

Schünemann HJ, Cushman M, Burnett AE, Kahn SR, Beyer-Westendorf J, Spencer FA, et al. American Society of Hematology 2018 guidelines for management of venous thromboembolism: prophylaxis for hospitalized and nonhospitalized medical patients. [published correction appears in Blood Adv. 2023 May 09;7(9):1671. doi: 10.1182/bloodadvances.2022008147.]. Blood Adv. 2018;2(22):3198-3225. doi:10.1182/bloodadvances.2018022954 DOI: https://doi.org/10.1182/bloodadvances.2018022954

Ra G, Thanabalan R, Ratneswaran S, Nguyen GC. Predictors and safety of venous thromboembolism prophylaxis among hospitalized inflammatory bowel disease patients. J Crohns Colitis. 2013;7(10):e479-e485. doi:10.1016/j.crohns.2013.03.002 DOI: https://doi.org/10.1016/j.crohns.2013.03.002

Patel SV, Liberman SA, Burgess PL, Goldberg JE, Poylin VY, Messick CA, et al. The American Society of Colon and Rectal Surgeons clinical practice guidelines for the reduction of venous thromboembolic disease in colorectal surgery. Dis Colon Rectum. 2023;66(9):1162-1173. doi:10.1097/DCR.0000000000002975 DOI: https://doi.org/10.1097/DCR.0000000000002975

Nguyen GC, Sharma S. Feasibility of venous thromboembolism prophylaxis during inflammatory bowel disease flares in the outpatient setting: a decision analysis. Inflamm Bowel Dis. 2013;19(10):2182-2189. doi:10.1097/MIB.0b013e31829c01ef DOI: https://doi.org/10.1097/MIB.0b013e31829c01ef

Iorio A, Kearon C, Filippucci E, Marcucci M, Macura A, Pengo V, et al. Risk of recurrence after a first episode of symptomatic venous thromboembolism provoked by a transient risk factor: a systematic review. Arch Intern Med. 2010;170(19):1710-1716. doi:10.1001/archinternmed.2010.367 DOI: https://doi.org/10.1001/archinternmed.2010.367

Leeds IL, DiBrito SR, Canner JK, Haut ER, Safar B. Cost-benefit limitations of extended, outpatient venous thromboembolism prophylaxis following surgery for Crohn’s disease. Dis Colon Rectum. 2019;62(11):1371-1380. doi:10.1097/DCR.0000000000001461

Vardi M, Ghanem-Zoubi NO, Zidan R, Yurin V, Bitterman H. Venous thromboembolism and the utility of the Padua Prediction Score in patients with sepsis admitted to internal medicine departments. J Thromb Haemost. 2013;11(3):467-473. doi:10.1111/jth.12108 DOI: https://doi.org/10.1111/jth.12108

Rosenberg D, Eichorn A, Alarcon M, McCullagh L, McGinn T, Spyropoulos AC. External validation of the risk assessment model of the International Medical Prevention Registry on Venous Thromboembolism (IMPROVE) for medical patients in a tertiary health system. J Am Heart Assoc. 2014;3(6):e001152. doi:10.1161/JAHA.114.001152 DOI: https://doi.org/10.1161/JAHA.114.001152

Chen X, Pan L, Deng H, Zhang J, Tong X, Huang H, et al. Risk assessment in Chinese hospitalized patients comparing the Padua and Caprini scoring algorithms. Clin Appl Thromb Hemost. 2018 Dec;24(9_suppl):127S-135S. doi:10.1177/1076029618797465 DOI: https://doi.org/10.1177/1076029618797465

Sarlos P, Szemes K, Hegyi P, Garami A, Szabo I, Illes A, et al. Steroid but not biological therapy elevates the risk of venous thromboembolic events in inflammatory bowel disease: a meta-analysis. J Crohn’s Colitis. 2018;12(4):489-498. doi:10.1093/ecco-jcc/jjx162 DOI: https://doi.org/10.1093/ecco-jcc/jjx162

Yoshida H, Yilmaz CE, Granger ND. Role of tumor necrosis factor-α in the extraintestinal thrombosis associated with colonic inflammation. Inflamm Bowel Dis. 2011;17(11):2217-2223. doi:10.1002/ibd.21593 DOI: https://doi.org/10.1002/ibd.21593

Food and Drug Administration Drug Safety Communication. FDA approves Boxed Warning about increased risk of blood clots and death with higher dose of arthritis and ulcerative colitis medicine tofacitinib (Xeljanz, Xeljanz XR). 2021: [Updated 4 February 2021, cited 26 June 2025]. Available from: https://www.fda.gov/drugs/drug-safety-and-availability/fda-approves-boxed-warning-about-increased-risk-blood-clots-and-death-higher-dose-arthritis-and

Trepanier M, Alhassan N, Sabapathy CA, Liberman AS, Charlebois P, Stein BL, et al. Cost-effectiveness of extended thromboprophylaxis in patients undergoing colorectal surgery from a Canadian health care system perspective. Dis Colon Rectum. 2019;62(11):1381-1389. doi:10.1097/DCR.0000000000001438 DOI: https://doi.org/10.1097/DCR.0000000000001438

Leeds IL, DiBrito SR, Canner JK, Haut ER, Safar B. Cost-benefit limitations of extended, outpatient venous thromboembolism prophylaxis following surgery for Crohn’s disease. Dis Colon Rectum. 2019;62(11):1371-1380. doi:10.1097/DCR.0000000000001461 DOI: https://doi.org/10.1097/DCR.0000000000001461

Leeds IL, Sklow B, Gorgun E, Liska D, Lightner AL, Hull TL, et al. Cost-effectiveness of aspirin for extended venous thromboembolism prophylaxis after major surgery for inflammatory bowel disease. J Gastrointest Surg. 2022;26(6):1275-1285. doi:10.1007/s11605-022-05287-z DOI: https://doi.org/10.1007/s11605-022-05287-z

Samama CM, Laporte S, Rosencher N, Girard P, Llau J, Mouret P, et al. Rivaroxaban or enoxaparin in nonmajor orthopedic surgery. N Engl J Med. 2020;382(20):1916-1925. doi:10.1056/NEJMoa1913808 DOI: https://doi.org/10.1056/NEJMoa1913808

Thrombosis Canada. Thromboprophylaxis: orthopedic surgery [Internet]. Toronto: Thrombosis Canada; 2020 May 11 [updated 13 March 2025, cited 2025 May 23]. Available from: https://thrombosiscanada.ca/hcp/practice/clinical_guides?language=en-ca&guideID=THROMBOPROPHYLAXISAFTERORTHOPE

Becattini C, Pace U, Pirozzi F, Donini A, Avruscio G, Rondelli F, et al. Rivaroxaban vs placebo for extended antithrombotic prophylaxis after laparoscopic surgery for colorectal cancer. Blood. 2022;140(8):900-908. doi:10.1182/blood.2022015796 DOI: https://doi.org/10.1182/blood.2022015796

Anderson DR, Morgano GP, Bennett C, Dentali F, Francis CW, Garcia DA, et al. American Society of Hematology 2019 guidelines for management of venous thromboembolism: prevention of venous thromboembolism in surgical hospitalized patients. Blood Adv. 2019;3(23):3898-3944. doi:10.1182/bloodadvances.2019000975 DOI: https://doi.org/10.1182/bloodadvances.2019000975

Cohen AT, Harrington RA, Goldhaber SZ, Hull RD, Wiens BL, Gold A, et al. Extended thromboprophylaxis with betrixaban in acutely ill medical patients. N Engl J Med. 2016;375(6):534-544. doi:10.1056/NEJMoa1601747 DOI: https://doi.org/10.1056/NEJMoa1601747

Spyropoulos AC, Ageno W, Albers GW, Elliott CG, Halperin JL, Hiatt WR, et al. Rivaroxaban for thromboprophylaxis after hospitalization for medical illness. N Engl J Med. 2018;379(12):1118-1127. doi:10.1056/NEJMoa1805090 DOI: https://doi.org/10.1056/NEJMoa1805090

Kaddourah O, Numan L, Jeepalyam S, Abughanimeh O, Ghanimeh MA, Abuamr K. Venous thromboembolism prophylaxis in inflammatory bowel disease flare-ups. Ann Gastroenterol. 2019;32(6):578-583. doi:10.20524/aog.2019.0412 DOI: https://doi.org/10.20524/aog.2019.0412

Published

2025-09-23

How to Cite

1.
Gozdzik M. Prevention of Venous Thromboembolism in Patients with Inflammatory Bowel Disease . Can IBD Today [Internet]. 2025 Sep. 23 [cited 2025 Sep. 28];3(2):34–39. Available from: https://canadianibdtoday.com/article/view/3-2-Gozdzik

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