Inflammatory bowel disease-associated thromboembolism: A systematic review of outcomes with anticoagulation versus catheter-directed thrombolysis
Article first published online: 29 JUL 2011
Copyright © 2011 Crohn's & Colitis Foundation of America, Inc.
Inflammatory Bowel Diseases
Volume 18, Issue 1, pages 161–171, January 2012
How to Cite
Tabibian, J. H. and Streiff, M. B. (2012), Inflammatory bowel disease-associated thromboembolism: A systematic review of outcomes with anticoagulation versus catheter-directed thrombolysis. Inflamm Bowel Dis, 18: 161–171. doi: 10.1002/ibd.21307
- Issue published online: 11 DEC 2011
- Article first published online: 29 JUL 2011
- Manuscript Accepted: 3 MAR 2010
- Manuscript Received: 10 JAN 2010
- inflammatory bowel disease;
- thrombolytic therapy;
- gastrointestinal hemorrhage;
Thromboembolism (TE) is a common extraintestinal complication of inflammatory bowel disease (IBD). Catheter-directed thrombolysis (CDT) is being increasingly used to treat TE but often evokes fears of hemorrhagic complications (HCs) in patients with IBD. We reviewed clinical outcomes with anticoagulation (AC) and CDT in IBD patients with TE.
Published cases of IBD patients with TE were identified by a PubMed search. Cases were divided into two groups based on treatment modality: AC alone or CDT. Pretreatment variables and treatment-related outcomes were compared between treatment groups.
Fifty-two cases of IBD-associated TE were identified. Thirty-five cases were treated with AC alone and 17 with CDT. There were no significant differences in pretreatment variables. Patients treated with CDT tended to be more likely to achieve complete or partial symptomatic (P = 0.02) and radiologic resolution (P = 0.06). Gastrointestinal (GI) and non-GI HCs tended to occur more frequently with CDT, although these differences were not statistically significant (P = 0.44 and 0.15, respectively).
CDT and AC both appear to be well tolerated by IBD patients with TE. CDT may be used preferentially in patients with life-threatening TE, while AC may be preferable in patients with less clinically significant TE or patients at higher risk for bleeding. Further prospective studies are warranted to confirm these results and more definitively identify the best therapeutic approach for patients with IBD-associated TE. (Inflamm Bowel Dis 2011;)