Inflammatory Bowel Disease and Risk of Major Bleeding During Anticoagulation for Venous Thromboembolism

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.


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.

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