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Open AccessReview

Venous Thromboembolism in Patients with Inflammatory Bowel Disease: The Role of Pharmacological Therapy and Surgery

1
Internal Medicine and Gastroenterology Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Roma, Italy
2
Università Cattolica del S. Cuore, 00168 Roma, Italy
3
Servizio di Gastroenterologia Territoriale ASL BAT, Barletta-Andria-Trani, 76123 Barletta, Andria, Trani, Italy
4
Humanitas Clinical and Research Center, IRCCS Rozzano, 20089 Milan, Italy
5
Department of Biomedical Sciences, Humanitas University, Rozzano, 20089 Milan, Italy
6
Digestive Surgery Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Roma, Italy
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2020, 9(7), 2115; https://doi.org/10.3390/jcm9072115
Received: 3 June 2020 / Revised: 30 June 2020 / Accepted: 2 July 2020 / Published: 4 July 2020
(This article belongs to the Special Issue Novel Therapies and Approaches to Inflammatory Bowel Disease (IBD))
Patients with inflammatory bowel disease (IBD) have an increased risk of venous thromboembolism (VTE). Alongside the traditional acquired and genetic risk factors for VTE, patients with IBD have pathogenic and clinical peculiarities that are responsible for the increased number of thromboembolic events occurring during their life. A relevant role in modifying this risk in a pro or antithrombotic manner is played by pharmacological therapies and surgery. The availability of several biological agents and small-molecule drugs with different mechanisms of action allows us to also tailor the treatment based on the individual prothrombotic risk to reduce the occurrence of VTE. Available review articles did not provide sufficient and updated knowledge on this topic. Therefore, we assessed the role of each single treatment, including surgery, in modifying the risk of VTE in patients with IBD to provide physicians with recommendations to minimize VTE occurrence. We found that the use of steroids, particularly if prolonged, increased VTE risk, whereas the use of infliximab seemed to reduce such risk. The data relating to the hypothesized prothrombotic risk of tofacitinib were insufficient to draw definitive conclusions. Moreover, surgery has an increased prothrombotic risk. Therefore, implementing measures to prevent VTE, not only with pharmacological prophylaxis but also by reducing patient- and surgery-specific risk factors, is necessary. Our findings confirm the importance of the knowledge of the effect of each single drug or surgery on the overall VTE risk in patients with IBD, even if further data, particularly regarding newer drugs, are needed. View Full-Text
Keywords: inflammatory bowel disease; venous thromboembolism; infliximab; tofacitinib; surgery inflammatory bowel disease; venous thromboembolism; infliximab; tofacitinib; surgery
MDPI and ACS Style

Papa, A.; Tursi, A.; Danese, S.; Rapaccini, G.; Gasbarrini, A.; Papa, V. Venous Thromboembolism in Patients with Inflammatory Bowel Disease: The Role of Pharmacological Therapy and Surgery. J. Clin. Med. 2020, 9, 2115.

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