Treatment of Thromboembolism in IBD: More Questions than Answers Venous thromboembolism (VTE) is a well-established complication of inflammatory bowel disease (IBD). IBD patients are at 3-4-fold higher risk of VTE compared to the general population, with lifetime cumulative risks approaching 30% by age 70 years. The mortality following VTE in the IBD population has been reported to be as high as 22%. Thus, a high index of suspicion and prompt treatment are critical in optimizing health outcomes following VTE. As in the general population, the mainstay of VTE treatment in those with IBD is anticoagulation therapy and, in select patients, use of thrombolytics. Because IBD patients frequently have active disease with gastrointestinal bleeding, there may be concerns regarding the safety of anticoagulation therapy. A meta-analysis of studies in which anticoagulation was used as primary treatment for IBD did not show increased risk of major bleeding. However, there remains a paucity of efficacy and safety data for treatment of VTE in the IBD population.
In this issue of Inflammatory Bowel Diseases, Tabibian and Streiff (Inflammatory Bowel Disease-associated Thromboembolism: A Systematic Review of Outcomes with Anticoagulation Versus Catheter-directed Thrombolysis) perform a systematic review of case reports and series describing outcomes of IBD patients who were treated for thromboembolism, of whom 35 received anticoagulation (AC) and 17 received IBD catheter-directed thrombolysis (CDT). In their analysis they found that all patients who were treated with CDT had at least partial resolution of symptoms compared to only three-quarters of those who received AC (P ΒΌ 0.02), with a marginally significantly higher rate of radiologic resolution (100% versus 74%, P ΒΌ 0.06). The authors did not show a statistically significant difference in treatment-related gastrointestinal (GI) or non-GI bleeding between those receiving AC and CDT.
Among the limitations of the study is the small sample size, which may have precluded the detection of differences in efficacy and especially hemorrhagic complications between the two treatment groups. The small sample size is further compounded by the heterogeneity of data collection and the site of thromboembolism, which affects severity and outcomes. Moreover, because case