title: Predictors and safety of venous thromboembolism prophylaxis among hospitalized inflammatory bowel disease patients.
abstract: BACKGROUND
  Inflammatory bowel disease (IBD) patients are at increased risk of venous thromboembolism (VTE) especially during hospitalization. We assessed the safety and predictors of VTE prophylaxis in this population.
  
  
  METHODS
  We conducted a retrospective study of 974 IBD admissions between February 2010 and May 2012. We abstracted data on clinical characteristics, VTE prophylaxis and bleeding events, and conducted multivariate analysis to determine predictors of prophylaxis.
  
  
  RESULTS
  Pharmacological VTE prophylaxis was administered to 80% of admissions; 63% were within 24h of admission. Patients on the surgical service (adjusted OR [aOR], 3.82; 95% CI: 2.00-7.29) and general medicine (aOR, 2.40; 95% CI: 1.39-4.12) were more likely to receive VTE prophylaxis compared to those on the gastroenterology service. Rectal bleeding on admission was associated with lower prophylaxis (aOR, 0.58; 95% CI: 0.35-0.97). The VTE prophylaxis rate increased from 47% to 73% (P<0.001) on non-surgical services with the introduction of a pharmacist advocate. The rates of major and minor bleeding were similar between patients who did and did not receive VTE prophylaxis (0.26 vs. 0 per 1000 person-days, P=0.7; 4.18 vs. 2.53 per 1000 person-days, P=0.4 respectively), and the major bleeding events (n=2) were post-operative. VTE prophylaxis was not associated with major postoperative bleeding (0.4% vs. 0%, P=0.96).
  
  
  CONCLUSIONS
  VTE prophylaxis was more frequent on the surgical service, where standardized protocols exist. The introduction of a pharmacist advocate greatly increased VTE prophylaxis on the non-surgical services. Prophylactic anticoagulation is safe in IBD despite the presence of rectal bleeding on admission.
authors.affiliation: Mount Sinai Hospital Centre for Inflammatory Bowel Disease, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Greta
authors.initials: G
authors.lastname: Ra
authors.forename: Reka
authors.initials: R
authors.lastname: Thanabalan
authors.forename: Sahana
authors.initials: S
authors.lastname: Ratneswaran
authors.forename: Geoffrey C
authors.initials: GC
authors.lastname: Nguyen
mesh_terms: D000328:Adult; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use*; D000075202:Contraindications; D005260:Female; D000077425:Fondaparinux; D006471:Gastrointestinal Hemorrhage / Q000209:etiology*; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use; D006748:Hospital Departments; D006760:Hospitalization; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000150:complications*; D008297:Male; D008875:Middle Aged; D010607:Pharmacy Service, Hospital; D011134:Polysaccharides / Q000627:therapeutic use; D010818:Practice Patterns, Physicians'; D012007:Rectum; D012189:Retrospective Studies; D054556:Venous Thromboembolism / Q000150:complications / Q000517:prevention & control*; D014859:Warfarin / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight; D011134:Polysaccharides; D014859:Warfarin; D000077425:Fondaparinux
keywords: Bleeding; Crohn's disease; Inflammatory bowel disease; Prophylaxis; Ulcerative colitis; Venous thromboembolism