Thromb Haemost 2001; 85(03): 430-434
DOI: 10.1055/s-0037-1615600
Review Article
Schattauer GmbH

The Incidence of Deep Venous Thrombosis and Pulmonary Embolism among Patients with Inflammatory Bowel Disease: A Population-based Cohort Study

Charles N. Bernstein
1   Departments of Internal Medicine and Community Health Sciences
James F. Blanchard
2   Medicine and Community Health Sciences, University of Manitoba and Epidemiology Unit
3   University of Manitoba and Epidemiology Unit, Winnipeg, Manitoba, Canada
Donald S. Houston
1   Departments of Internal Medicine and Community Health Sciences
Andre Wajda
2   Medicine and Community Health Sciences, University of Manitoba and Epidemiology Unit
3   University of Manitoba and Epidemiology Unit, Winnipeg, Manitoba, Canada
› Author Affiliations
Further Information

Publication History

Received 22 August 2000

Accepted after resubmission 11 October 2000

Publication Date:
08 December 2017 (online)


Background: There is an impression mostly from specialty clinics that patients with inflammatory bowel disease (IBD) have an increased risk of venous thromboembolic disorders. Our aim was to determine the incidence of deep venous thrombosis (DVT) and pulmonary embolism (PE) from a population-based database of IBD patients and, to compare the incidence rates to that of an age, gender and geographically matched population control group.

Methods: IBD patients identified from the administrative claims data of the universal provincial insurance plan of Manitoba were matched 1:10 to randomly selected members of the general population without IBD by year, age, gender, and postal area of residence using Manitoba Health’s population registry. The incidence of hospitalization for DVT and PE was calculated from hospital discharge abstracts using ICD-9-CM codes 451.1, 453.x for DVT and 415.1x for PE. Rates were calculated based on person-years of follow-up for 1984-1997. Comparisons to the population cohort yielded age-adjusted incidence rate ratios (IRR). Rates were calculated based on person-years of follow-up (Crohn’s disease = 21,340, ulcerative colitis = 19,665) for 1984-1997.

Results: In Crohn’s disease the incidence rate of DVT was 31.4/10,000 person-years and of PE was 10.3/10,000 person-years. In ulcerative colitis the incidence rates were 30.0/10,000 person-years for DVT and 19.8/10,000 person-years for PE. The IRR was 4.7 (95% CI, 3.5-6.3) for DVT and 2.9 (1.8-4.7) for PE in Crohn’s disease and 2.8 (2.1-3.7) for DVT and 3.6 (2.5-5.2) for PE, in ulcerative colitis. There were no gender differences for IRR. The highest rates of DVT and PE were seen among patients over 60 years old; however the highest IRR for these events were among patients less than 40 years.

Conclusion: IBD patients have a threefold increased risk of developing DVT or PE.

  • References

  • 1 Talbot RW, Heppell J, Dozois RR, Beart RW. Vascular complications of inflammatory bowel disease. Mayo Clin Proc 1986; 61: 140-5.
  • 2 Jackson LM, O’Gorman PJ, O’Connell J, Cronin CC, Cotter KP, Shanahan F. Thrombosis in inflammatory bowel disease: clinical setting, procoagulant profile and factor V Leiden. Quart J. Med 1997; 90: 183-8.
  • 3 Liebman HA, Kashani N, Sutherland D, McGehee W, Kam L. The factor V Leiden mutation increases the risk of venous thrombosis in patients with inflammatory bowel disease. Gastroenterology 1998; 115: 830-4.
  • 4 Novacek G, Miehsler W, Kapiotis S, Katzenschlager R, Speiser W, Vogelsang H. Thromboembolism and resistance to activated protein C in patients with inflammatory bowel disease. Amer J. Gastroenterol 1999; 94: 685-90.
  • 5 Roos LL, Mustard CA, Nicol JP. Registries and administrative data: organization and accuracy. Med Care 1993; 31: 201-12.
  • 6 Bernstein CN, Rawsthorne P, Wajda A, Blanchard JF. The high rates of Crohn’s disease and ulcerative colitis in a central Canadian province: A population-based study. Amer J. Epidemiol 1999; 149: 916-24.
  • 7 Rodeghiero F, Tosetto A. Activated protein C resistance and factor V Leiden mutation are independent risk factors for venous thromboembolism. Ann Intern Med 1999; 130: 643-50.
  • 8 Zauber NP, Sabbath-Solitare M, Rajoria G, Mogan G. Factor V Leiden mutation is not increased in patients with inflammatory bowel disease. J Clin Gastroenterol 1998; 27: 215-6.
  • 9 Over HH, Ulgen S, Tuglular T, Tezel A, Avsar E, Geyik G, Basgul S, Sayhan N, Ulusoy N, Kalayci C, Tozun N. Thrombophilia and inflammatory bowel disease: does factor V mutation have a role?. Eur J. Gastroenterol Hepatol 1998; 10: 827-9.
  • 10 Souto JC, Martinez E, Roca M, Mateo J, Pujol J, Gonzalez D, Fontcuberta J. Prothrombotic state and signs of endothelial lesion in plasma of patients with inflammatory bowel disease. Dig Dis Sci 1995; 40: 1883-9.
  • 11 Aadland E, Odegard OR, Roseth A, Try K. Free protein S deficiency in patients with chronic inflammatory bowel disease. Scand J Gastroenterol 1992; 27: 957-60.
  • 12 Chamouard P, Grunebaum L, Wiesel M-L, Freyssinet J-M, Duclos B, Cazenave J-P, Baumann R. Prevalence and significance of anticardiolipin antibodies in Crohn’s disease. Dig Dis Sci 1994; 39: 1501-4.
  • 13 Souto JC, Borrel M, Fontcuberta J, Roca M. Dig Dis Sci 1995; 40: 1524-5 (letter).
  • 14 Aichbichler BW, Petritsch W, Reicht GA, Wenzl HH, Eherer AJ, Hinterleitner TA, Auer-Grumbach P, Krejs GJ. Anti-cardiolipin antibodies in patients with inflammatory bowel disease. Dig Dis Sci 1999; 44: 852-6.
  • 15 Koutroubakis IE, Petinaki E, Anagnostopoulou E, Kritikos H, Mouzas IA, Kouroulamis EA, Manousos ON. Anti-cardiolipin and anti- 2-glyco-protein I antibodies in patients with inflammatory bowel disease. Dig Dis Sci 1998; 43: 2507-12.
  • 16 den Heijer M, Rosendaal FR, Blom HJ, Gerrits WB, Bos GM. Hyperhomocysteinemia and venous thrombosis: a meta-analysis. Thromb and Haemost 1998; 80: 874-7.
  • 17 Cattaneo M, Vecchi M, Zighetti ML, Saibeni S, Martinelli I, Omodei P, Mannucci PM, de Franchis R. High prevalence of hyperhomocysteinemia in patients with inflammatory bowel disease: a pathogenetic link with thromboembolic complications?. Thromb Haemost 1998; 80: 542-5.
  • 18 Lambert D, Benhayoun S, Adjalla C, Gelot M-A, Renkes P, Felden F, Gerard P, Belleville F, Gaucher P, Gueant J-L, Nicolas J-P.. Crohn’s disease and vitamin B12 metabolism. Dig Dis Sci 1996; 41: 1417-22.
  • 19 Chiarantini E, Valanzano R, Liotta AA, Cellai AP, Fedi S, Ilari I, Prisco D, Tonelli F, Abbate R. Hemostatic abnormalities in inflammatory bowel disease. Thrombosis Res 1996; 82: 137-46.
  • 20 Smith CJ, Haire WD, Kaufman SS, Mack DR. Determination of prothrombin activation fragments in young patients with inflammatory bowel disease. Am J Gastroenterol 1996; 91: 1221-5.
  • 21 Novacek G, Kapiotis S, Moser G, Speiser W, Gangl A, Vogelsang H. No evidence of activated blood coagulation in Crohn’s disease. Eur J. Gastroenterol Hepatol 1997; 9: 963-7.
  • 22 Hudson M, Chitolie A, Hutton RA. et al. Thrombotic vascular risk factors in inflammatory bowel disease. Gut 1996; 38: 733-7.
  • 23 Stevens TRJ, James JP, Simmonds NJ, McArthy DA, Laurenson IF, Maddison PG. et al. Circulating von Willebrand factor in inflammatory bowel disease. Gut 1992; 33: 502-6.
  • 24 De Jong E, Porte RJ, Knot EAR, Verheijen JH, Dees J. Disturbed fibrinolysis in patients with inflammatory bowel disease. A study in blood plasma, colon mucosa, and faeces. Gut 1989; 30: 188-94.
  • 25 Webberly MJ, Hart MT, Melikian V. Thromboembolism in inflammatory bowel disease: role of platelets. Gut 1993; 34: 247-51.
  • 26 Collins CE, Cahill MR, Newland AC, Rampton DS. Platelets circulate in activated state in inflammatory bowel disease. Gastroenterology 1994; 106: 840-5.
  • 27 Harries AD, Fitzsimmons E, Fifield R, Dew MJ, Rhodes J. Platelet count; a simple measure of activity in Crohn’s disease. BMJ 1983; 286: 1476.