scholarly journals P361 No increased postoperative risk of venous thromboembolism in patients with Ulcerative Colitis undergoing colectomy after tofacitinib exposure

2021 ◽  
Vol 15 (Supplement_1) ◽  
pp. S380-S380
Author(s):  
I De Greef ◽  
B Verstockt ◽  
G Bislenghi ◽  
I Terrasson ◽  
J Sabino ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Venous Thromboembolism ◽  
Colon Adenocarcinoma ◽  
Relevant Information ◽  
Perioperative Therapy ◽  
Postoperative Fever ◽  
Underlying Malignancy ◽  
Increased Risk ◽  
Bowel Diseases ◽  
N 93

Abstract Background Colectomy for ulcerative colitis (UC) has been associated with postoperative morbidity and mortality, including venous thromboembolism (VTE). Patients with inflammatory bowel diseases (IBD) have a 2 to 4-fold increased risk for developing VTE, as compared to non-IBD patients. Due to recent concerns on increased VTE associated with tofacitinib exposure, we aimed to evaluate the 180-day postoperative VTE risk in UC patients undergoing colectomy after tofacitinib use in comparison to patients failing biologicals and undergoing the same surgery. Methods This retrospective cohort study included all UC patients who underwent colectomy between 2014 and 2020 in our tertiary IBD center. All medical charts were reviewed, and clinically relevant information extracted, including indication for colectomy, development of postoperative VTE (deep venous thrombosis, pulmonary or extra-pulmonary embolisms) within 180 days of surgery, low-molecular weight heparin (LMWH) prophylaxis and perioperative therapy exposure (steroids within 1 month prior to surgery, biologicals or tofacitinib within 3 months prior to surgery). Results One-hundred seven UC patients (49.5% women, median [IQR] age 38.0 [27.0 – 53.0] years) underwent colectomy due to refractory disease (n=93), dysplasia or carcinoma (n=12) or polyposis (n=2) (Table 1). Thirty-six (33.6%) patients were operated urgently. At the time of surgery, 44 (41.1%) were on steroids, 38 (35.5%) on anti-TNF agents, 27 (25.2%) on vedolizumab/etrolizumab, 6 (5.6%) on anti-IL12/23 agents and 12 (11.2%) on tofacitinib. All patients received antithrombotic prophylactic LMWH postoperatively. During the 180-day postoperative period, 3 (2.8%) patients developed an intra-abdominal thrombosis, none of them had a history of VTE. Two thromboses were found by coincidence on CT scans which were performed in light of postoperative fever and inflammatory blood tests, the other patient was symptomatic. All 3 patients had been exposed to vedolizumab: one had an underlying malignancy (colon adenocarcinoma), the 2 others also had been exposed to corticosteroids prior to colectomy. No VTE was seen in the patients who underwent colectomy while on tofacitinib. Conclusion The overall risk for UC patients to develop VTE after colectomy is low with adequate antithrombotic prophylactic therapy. In particular, we did not observe any VTE in our colectomy patients who were exposed to tofacitinib prior to surgery. The three patients who developed VTE despite LMWH had additional risk factors (concomitant steroid use, active cancer).

Ulcerative Colitis Is Associated With an Increased Risk of Venous Thromboembolism in the Postoperative Period

2015 ◽  
Vol 261 (6) ◽  
pp. 1160-1166 ◽  
Author(s):  
Matthew Z. Wilson ◽  
Tara M. Connelly ◽  
Andrew Tinsley ◽  
Christopher S. Hollenbeak ◽  
Walter A. Koltun ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Venous Thromboembolism ◽  
Postoperative Period ◽  
Increased Risk

Contraception, Venous Thromboembolism, and Inflammatory Bowel Disease: What Clinicians (and Patients) Should Know

2019 ◽  
Vol 25 (10) ◽  
pp. 1603-1612 ◽  
Author(s):  
Jimmy K Limdi ◽  
Jennifer Farraye ◽  
Rachel Cannon ◽  
Elisabeth Woodhams ◽  
Francis A Farraye
Keyword(s):  
Preterm Birth ◽  
Venous Thromboembolism ◽  
Primary Care Physicians ◽  
Hormonal Contraceptives ◽  
Increased Risk ◽  
Bowel Diseases ◽  
Inflammatory Bowel ◽  
Maternal And Neonatal Outcomes ◽  
Adverse Pregnancy ◽  
Contraception Counseling

Abstract The peak incidence of the inflammatory bowel diseases (IBDs) is between the second and fourth decades of life, which coincides with prime reproductive years. Unplanned or mistimed pregnancies may account for nearly half of all pregnancies and are associated with adverse consequences such as a higher risk of delayed preconceptual care, increased risk of preterm birth, low birth weight, and adverse maternal and neonatal outcomes. Increased IBD activity during pregnancy is also associated with adverse pregnancy-related outcomes, such as miscarriage, intrauterine growth retardation, and preterm birth. Furthermore, the increased risk of venous thromboembolism (VTE) conferred by active IBD may be potentially augmented by hormonal contraceptives. Recent literature suggests that women with IBD seek counseling on contraception from gastroenterologists in preference to their primary care physicians. Meanwhile, attitudes and awareness regarding contraception counseling remain suboptimal, underpinning the importance and need for physician and patient education in this area. We discuss the association between contraception and IBD, benefits and risks associated with various contraceptive methods in women with IBD, and practical recommendations for clinicians caring for women with IBD. 10.1093/ibd/izz025_video1 izz025.video1 6014727518001 10.1093/ibd/izz025_video2 izz025.video2 6014726992001

scholarly journals Minerals and Bone Mineral Density in Inflammatory Bowel Diseases

2020 ◽  
Author(s):  
Alicja Ewa Ratajczak ◽  
Anna Maria Rychter ◽  
Agnieszka Zawada ◽  
Agnieszka Dobrowolska ◽  
Iwona Krela-Kaźmierczak
Keyword(s):  
Bone Mineral Density ◽  
Ulcerative Colitis ◽  
Bone Mass ◽  
Bone Mineral ◽  
Inflammatory Bowel Diseases ◽  
Mineral Density ◽  
Low Bone Mineral Density ◽  
Increased Risk ◽  
Bowel Diseases ◽  
Inflammatory Bowel

The chronic character of inflammatory bowel diseases, such as Crohn’s disease and ulcerative colitis, results in various complications. One of them is osteoporosis, manifested by low bone mineral density, which leads to an increased risk of fractures. The aetiology of low bone mineral density is multifactorial and includes both diet and nutritional status. Calcium is the most often discussed minerals with regard to bone mineral density. Moreover, phosphorus; magnesium and sodium are also involved in the formation of bone mass. Patients suffering from inflammatory bowel diseases frequently consume inadequate amounts of the aforementioned minerals  or their absorption is disturbed, resulting innutritional deficiency and an increased risk of osteoporosis. 

scholarly journals Risk of venous thromboembolism in immune-mediated inflammatory diseases: a UK matched cohort study

RMD Open ◽  
2020 ◽  
Vol 6 (3) ◽  
pp. e001392
Author(s):  
James Galloway ◽  
Kevin Barrett ◽  
Peter Irving ◽  
Kaivan Khavandi ◽  
Monica Nijher ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ulcerative Colitis ◽  
Venous Thromboembolism ◽  
Proportional Hazards ◽  
Inflammatory Diseases ◽  
Clinical Information ◽  
Cox Proportional Hazards ◽  
Smoking History ◽  
Immune Mediated ◽  
Increased Risk

ObjectivesTo describe the risk of venous thromboembolism (VTE), and risk factors for VTE, in people with immune-mediated inflammatory diseases (IMID) (ulcerative colitis, Crohn’s disease (CD), rheumatoid arthritis (RA) and psoriatic arthritis (PsA)), compared with a matched control population.MethodsA total of 53 378 people with an IMID were identified over 1999–2019 in the UK Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC) primary care database and were matched to 213 512 people without an IMID. The association between the presence of any IMID, and each IMID separately, and risk of VTE was estimated using unadjusted and multivariable-adjusted Cox proportional hazards models. The prevalence of VTE risk factors, and associations between VTE risk factors and risk of VTE, were estimated in people with and without an IMID.ResultsPeople with an IMID were at increased risk of VTE (adjusted HR [aHR] 1.46, 95% CI 1.36,1.56), compared with matched controls. When assessing individual diseases, risk was increased for CD (aHR 1.74, 95% CI 1.45 to 2.08), ulcerative colitis (aHR 1.27, 95% CI 1.10 to 1.45) and RA (aHR 1.54, 95% CI 1.40 to 1.70) but there was no evidence of an association for PsA (aHR 1.21, 95% CI 0.96 to 1.52). In people with an IMID, independent risk factors for VTE included male sex, overweight/obese body mass index, current smoking, history of fracture, and, across study follow-up, abnormal platelet count.ConclusionsVTE risk is increased in people with IMIDs. Routinely available clinical information may be helpful to identify individuals with an IMID at increased future risk of VTE.Observational study registration numberClinicaltrials.gov (NCT03835780).

Tacrolimus Therapy in Steroid-Refractory Ulcerative Colitis: A Review

2019 ◽  
Vol 26 (1) ◽  
pp. 24-32 ◽  
Author(s):  
Biyu Wu ◽  
Jinglu Tong ◽  
Zhihua Ran
Keyword(s):  
Ulcerative Colitis ◽  
Inflammatory Process ◽  
Calcineurin Inhibitor ◽  
Efficacy And Safety ◽  
Chronic Inflammatory Process ◽  
Increased Risk ◽  
Bowel Diseases ◽  
Tacrolimus Therapy ◽  
Inflammatory Bowel ◽  
Steroid Refractory

AbstractInflammatory bowel diseases are known for a chronic inflammatory process of the gastrointestinal tract and include Crohn’s disease and ulcerative colitis (UC). Patients who are dependent on or resistant to corticosteroids account for about 20% of severe UC patients. Tacrolimus is a calcineurin inhibitor that has recently been used in the treatment of steroid-refractory ulcerative colitis. Tacrolimus has been demonstrated to have remarkable therapeutic efficacy in UC patients, without increased risk of severe adverse effects such as induction of remission and maintenance therapy. This article reviews the mechanism of action, pharmacogenetics, efficacy, and safety of tacrolimus for patients with steroid-refractory ulcerative colitis.

scholarly journals Concerns and attitudes of patients with inflammatory bowel diseases during the COVID-19 pandemic

2020 ◽  
Author(s):  
Matina-Lydia Chatzinikolaou ◽  
Eirini Zacharopoulou ◽  
Georgios Kokkotis ◽  
Maria Palatianou ◽  
Stamatina Vogli ◽  
...  
Keyword(s):  
Preventive Measures ◽  
Relevant Information ◽  
Sources Of Information ◽  
Sense Of Security ◽  
Increased Risk ◽  
Bowel Diseases ◽  
Negative Effect ◽  
Inflammatory Bowel ◽  
Coronavirus Infection ◽  
The Impact

Abstract Background: The coronavirus disease 2019 (COVID-19) pandemic has changed inflammatory bowel disease (IBD) care. The use of telemedicine was quickly adopted, however the impact of COVID-19 on IBD patients’ feelings and sense of security for their health has not been extensively evaluated.Aims: Our aim was to assess patients’ views and concerns regarding their IBD condition, compliance with treatment and preventive measures, accessibility to health services and sources of information they used during the coronavirus pandemic.Methods: A questionnaire-based survey of patients with IBD (n=237) was conducted at a University and an NHS GI Units.Results: Greek patients with IBD expressed high levels of fear of coronavirus infection, with more than 50% being afraid of dying as a result of COVID-19. Seven out of ten participants felt that their IBD medications increased risk of infection and this fear was significantly higher in patients on immunosuppression. Only 2% of patients discontinued treatment on their own, all of whom were receiving immunosuppression. More than 90% of participants reported staying home and washing their hands. Three quarters of patients had access to a doctor when needed and almost 50% used the electronic paperless prescription system. Participants were satisfied with the information they received regarding COVID-19. The main sources of information were media, internet and social networks, with only one third seeking guidance from their gastroenterologist. Conclusions: The COVID-19 pandemic had a profound, negative effect on IBD patients’ lives. COVID-19-related fears need to be actively addressed, particularly in IBD patients on immunosuppression, and relevant information should be continuously provided.

Improving the Quality of Inpatient Ulcerative Colitis Management: Promoting Evidence-Based Practice and Reducing Care Variation With an Inpatient Protocol

2019 ◽  
Vol 25 (11) ◽  
pp. 1822-1827 ◽  
Author(s):  
Sara M Lewin ◽  
Ryan A McConnell ◽  
Roshan Patel ◽  
Suzanne R Sharpton ◽  
Fernando Velayos ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Venous Thromboembolism ◽  
Oral Morphine ◽  
Quality Improvement Intervention ◽  
Evidence Based ◽  
Thromboembolism Prophylaxis ◽  
Disease Extent ◽  
Vte Prophylaxis ◽  
Increased Risk ◽  
Evidence Based Care

Abstarct Background Hospitalization for ulcerative colitis is a high-risk period associated with increased risk of Clostridium difficile infection, thromboembolism, and opiate use. The study aim was to develop and implement a quality-improvement intervention for inpatient ulcerative colitis management that standardizes gastroenterology consultant recommendations and improves delivery of evidence-based care. Methods All adult patients hospitalized for ulcerative colitis between July 1, 2014, and December 31, 2017, who received intravenous corticosteroids were included. On July 1, 2016, the UCSF Inpatient Ulcerative Colitis Protocol was implemented, featuring standardized core recommendations and a daily checklist for gastroenterology consultant notes, a bundled IBD electronic order set, and an opiate awareness campaign. The composite primary outcome was adherence to all 3 evidence-based care metrics: C. difficile testing performed, pharmacologic venous thromboembolism (VTE) prophylaxis ordered, and opiates avoided. Results Ninety-three ulcerative colitis hospitalizations occurred, including 36 preintervention and 57 postintervention. Age, gender, disease duration, disease extent, and medication use were similar preintervention and postintervention. C. difficile testing was performed in 100% of hospitalizations. Venous thromboembolism prophylaxis was ordered on 84% of hospital days before intervention compared with 100% after intervention (P ≤ 0.001). Opiates were administered in 67% of preintervention hospitalizations, compared with 53% of postintervention hospitalizations (P = 0.18). The median daily dose of oral morphine equivalents decreased from 12.1 mg before intervention to 0.5 mg after intervention (P = 0.02). The composite outcome of adherence to all 3 metrics was higher after intervention (25% vs. 47%, P = 0.03). Conclusions Evidence-based inpatient ulcerative colitis management may be optimized with standardized algorithms that reinforce core principles, reduce care variation, and do not require IBD specialists to implement.

scholarly journals Efficacy of fidaxomicin therapy, after failure of vancomycin therapy, for treating a C. difficile colitis in a patient with ulcerative colitis

2015 ◽  
Vol 9 (1S) ◽  
pp. 7-10
Author(s):  
Carlo Tascini ◽  
Federico Corti ◽  
Gualtiero Bottari ◽  
Paola Lambelet
Keyword(s):  
Ulcerative Colitis ◽  
Vancomycin Therapy ◽  
Increased Risk ◽  
Days Of Therapy ◽  
Bowel Diseases ◽  
Fluconazole Therapy ◽  
Inflammatory Bowel ◽  
Inflammatory Diarrhea ◽  
Anti Fungal

Patients with inflammatory bowel diseases (IBDs) have greater risk of developing C. difficile infection (CDI). In these patients, CDI have worse outcome, may be associated with increased risk of bacteremia and candidemia and may be misdiagnosed as relapse of IBD, also because ofthe absence of typical findings of CDI at colonoscopy.A 58-year-old man with acute ulcerative colitis treated with steroids was hospitalized for feverand recrudescence of inflammatory diarrhea. During the hospitalization, the fever was treated with broad spectrum antibiotics and systemic anti-fungal therapy. Candida mannan antigenand the molecular screening for C. difficile resulted positive. A first course of vancomycin by mouthwas unsuccessful, therefore we started a 10-day course of fidaxomicin. After five days of therapy, diarrhea disappeared. A few-week course of fluconazole therapy was performed to complete the treatment of invasive candidiasis. At six-month follow-up no relapse of CDI was documented.

scholarly journals High Incidence of Postoperative Silent Venous Thromboembolism in Ulcerative Colitis

2021 ◽  
Author(s):  
Norimitsu Shimada ◽  
Hiroki Ohge ◽  
Hiroki Kitagawa ◽  
Kosuke Yoshimura ◽  
Norifumi Shigemoto ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Venous Thromboembolism ◽  
Total Colectomy ◽  
Univariate Analysis ◽  
High Serum ◽  
Total Proctocolectomy ◽  
Bowel Diseases ◽  
Colon And Rectum ◽  
Predictive Risk ◽  
D Dimer

Abstract Purpose: The incidence of postoperative venous thromboembolism (VTE) is high in patients with inflammatory bowel diseases. We aimed to analyze the incidence and predictive factors of postoperative VTE.Methods: Patients with ulcerative colitis who underwent colon and rectum surgery during 2010–2018 were included. We retrospectively investigated the incidence of postoperative VTE.Results: A total 140 cases of colorectal surgery were included. Postoperative VTE was detected in 24 (17.1%). All patients with VTE had no specific symptoms related to thrombus, except one pulmonary embolism. Portal–mesenteric venous thrombosis was the most frequent (18, 75%); of these, 15 patients underwent total proctocolectomy (TPC) with ileal pouch–anal anastomosis (IPAA). In univariate analysis, VTE occurred more frequently in patients with neoplasia than refractory to medications (27.2% vs. 12.5%; p<0.031). TPC with IPAA was more associated with developing VTE (28%) than total colectomy (10.5%) or proctectomy (5.9%). On logistic regression analysis of predictive risk factors, TPC with IPAA, total colectomy, longer operative time (>4 hours), and high serum D-dimer levels (>5.3 μg/mL) the day following surgery were identified. Conclusion: Postoperative VTE occurred frequently and asymptomatic, especially after TPC with IPAA. D-dimer the day after surgery may be useful predictor of VTE.

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