Consensus statements on the risk, prevention, and treatment of venous thromboembolism in inflammatory bowel disease: Canadian Association of Gastroenterology.
OBJECTIVE
Guidelines for the management of venous thromboembolism (VTE) from the American College of Chest Physicians do not address patients with inflammatory bowel disease (IBD), a group with a high risk of both VTE and gastrointestinal bleeding. We present recommendations for the prevention and treatment of VTE in patients with IBD.


METHODS
A systematic literature search was performed to identify studies on VTE in IBD. The quality of evidence and strength of recommendations were rated according to the Grading of Recommendation Assessment, Development, and Evaluation (GRADE) approach. Statements were developed through an iterative online platform, then finalized and voted on by a working group of adult and pediatric gastroenterologists and thrombosis specialists.


RESULTS
IBD patients have an approximately 3-fold higher risk of VTE compared with individuals without IBD, and disease flares further increase this risk. Anticoagulant thromboprophylaxis is recommended for IBD patients who are hospitalized with IBD flares without active bleeding and is suggested when bleeding is nonsevere. Anticoagulant thromboprophylaxis is suggested during moderate-severe IBD flares in outpatients with a history of VTE provoked by an IBD flare or an unprovoked VTE, but not otherwise. The recommended duration of anticoagulation after a first VTE is based on the presence of provoking factors. Specific suggestions are made for the prevention and treatment of VTE in pediatric and pregnant IBD patients.


CONCLUSIONS
Using the American College of Chest Physicians' guidelines as a foundation, we have integrated evidence from IBD studies to develop specific recommendations for the management of VTE in this high-risk population.
Mount Sinai Hospital Centre for Inflammatory Bowel Disease, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada. Electronic address: geoff.nguyen@utoronto.ca.
Geoffrey C
GC
Nguyen
IBD Clinical and Research Centre, University of Manitoba, Winnipeg, Manitoba, Canada.
Charles N
CN
Bernstein
Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada.
Alain
A
Bitton
Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.
Anthony K
AK
Chan
Division of Gastroenterology, Hepatology, and Nutrition, Sick Kids Hospital, Toronto, Ontario, Canada.
Anne M
AM
Griffiths
Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
Grigorios I
GI
Leontiadis
Thromboembolism Program, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
William
W
Geerts
Department of Medicine, Division of Gastroenterology, St Paul's Hospital, Vancouver, British Columbia, Canada.
Brian
B
Bressler
Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada.
J Decker
JD
Butzner
Clinical Epidemiology Program, The Ottawa Hospital, Ottawa, Ontario, Canada.
Marc
M
Carrier
Division of Gastroenterology, Western University, London, Ontario, Canada.
Nilesh
N
Chande
Hamilton Health Sciences Centre, Hamilton, Ontario, Canada.
John K
JK
Marshall
Dalhousie University, Halifax, Nova Scotia; Memorial University, St John's, Newfoundland, Canada.
Chadwick
C
Williams
Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
Clive
C
Kearon
D000367:Age Factors; D000925:Anticoagulants / Q000627:therapeutic use; D019468:Disease Management; D019983:Guideline Adherence; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000150:complications*; D061185:Mechanical Thrombolysis; D012307:Risk Factors; D054556:Venous Thromboembolism / Q000453:epidemiology / Q000517:prevention & control* / Q000628:therapy*
D000925:Anticoagulants
Anticoagulant Therapy; Crohn’s Disease; Inflammatory Bowel Disease; Ulcerative Colitis; Venous Thromboembolism