Inflamm Bowel Dis. 2021 Jan 2;izaa337. doi: 10.1093/ibd/izaa337. Online ahead of print.

Susanna Scharrer ¹, Christian Primas ¹, Sabine Eichinger ², Sebastian Tonko ^1 3, Maximilian Kutschera ¹, Robert Koch ⁴, Andreas Blesl ⁵, Walter Reinisch ¹, Andreas Mayer ⁶, Thomas Haas ⁷, Thomas Feichtenschlager ⁸, Harry Fuchssteiner ⁹, Pius Steiner ¹⁰, Othmar Ludwiczek ¹¹, Reingard Platzer ¹², Wolfgang Miehsler ¹³, Wolfgang Tillinger ¹⁴, Sigrid Apostol ¹⁵, Alfons Schmid ¹⁶, Karin Schweiger ¹⁷, Harald Vogelsang ¹, Clemens Dejaco ¹, Harald Herkner ¹⁸, Gottfried Novacek ¹

Author information

• ¹Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria.
• ²Department of Internal Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria.
• ³Praxis am rhy AG, Kriessern, Switzerland.
• ⁴Department of Internal Medicine I, Medical University of Innsbruck, Innsbruck, Austria.
• ⁵Department of Internal Medicine, Division of Gastroenterology and Hepatology, Medical University of Graz, Graz, Austria.
• ⁶Department of Internal Medicine II, Universitätsklinikum St. Pölten, St. Pölten, Austria.
• ⁷Darmpraxis, Salzburg, Austria.
• ⁸Department of Internal Medicine IV, Hospital Rudolfstiftung, Vienna, Austria.
• ⁹Department of Internal Medicine IV, Hospital Elisabethinen Linz, Linz, Austria.
• ¹⁰Department of Internal Medicine I, Hospital Wels-Grieskirchen, Wels, Austria.
• ¹¹Department of Internal Medicine, Hospital Hall, Tyrol, Austria.
• ¹²Department of Internal Medicine I, Hospital Wiener Neustadt, Wiener Neustadt, Austria.
• ¹³Department of Internal Medicine, Hospital Brothers of St. John of God Salzburg, Salzburg, Austria.
• ¹⁴Department of Internal Medicine, Franziskus Hospital, Vienna, Austria.
• ¹⁵Department of Internal Medicine, Hietzing Clinic, Vienna, Austria.
• ¹⁶Department of Internal Medicine 2, Danube Hospital, Vienna, Austria.
• ¹⁷Department of Internal Medicine 4, Ottakring Clinic, Vienna, Austria.
• ¹⁸Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria.

Abstract

Background: Little is known about the bleeding risk in patients with inflammatory bowel disease (IBD) and venous thromboembolism (VTE) treated with anticoagulation. Our aim was to elucidate the rate of major bleeding (MB) events in a well-defined cohort of patients with IBD during anticoagulation after VTE.

Methods: This study is a retrospective follow-up analysis of a multicenter cohort study investigating the incidence and recurrence rate of VTE in IBD. Data on MB and IBD- and VTE-related parameters were collected via telephone interview and chart review. The objective of the study was to evaluate the impact of anticoagulation for VTE on the risk of MB by comparing time periods with anticoagulation vs those without anticoagulation. A random-effects Poisson regression model was used.

Results: We included 107 patients (52 women, 40 with ulcerative colitis, 64 with Crohn disease, and 3 with unclassified IBD) in the study. The overall observation time was 388 patient-years with and 1445 patient-years without anticoagulation. In total, 23 MB events were registered in 21 patients, among whom 13 MB events occurred without anticoagulation and 10 occurred with anticoagulation. No fatal bleeding during anticoagulation was registered. The incidence rate for MB events was 2.6/100 patient-years during periods exposed to anticoagulation and 0.9/100 patient-years during the unexposed time. Exposure to anticoagulation (adjusted incidence rate ratio, 3.7; 95% confidence interval, 1.5-9.0; P = 0.003) and ulcerative colitis (adjusted incidence rate ratio, 3.5; 95% confidence interval, 1.5-8.1; P = 0.003) were independent risk factors for MB events.

Conclusion: The risk of major but not fatal bleeding is increased in patients with IBD during anticoagulation. Our findings indicate that this risk may be outweighed by the high VTE recurrence rate in patients with IBD.