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Inflammatory bowel disease increases risk of thrombosis

(Vienna, 11 Oct. 2010) Some time ago, scientists of MedUni Vienna were able to prove that inflammatory bowel disease (IBD), the main forms of which are Crohn's disease and ulcerative colitis, constitute a risk factor for the development of thromboses. Another recent study has shown that IBD can also encourage the recurrence of blood clot formation following completion of an anticoagulant therapy. The article, which has received widespread attention, has now been published in the internationally renowned medical journal "Gastroenterology".

Inflammatory bowel disease (IBD) is found increasingly in the industrialised countries. The number of patients in the inpatient field in Austria has jumped by 270% in the last 15 years. The cause of IBD is not known. A long-term therapy, among other options with immunosuppressive effective medication, is often required. Nevertheless, it is not rare for patients to suffer from progressive intestine damage accompanied by the development of complications, which necessitates an operative procedure. In addition, extraintestinal manifestations and complications can develop (outside the intestine), which also include thromboses and potentially life-threatening lung embolisms.

It has already be proven in a study*) conducted by MedUni Vienna some time ago that IBD represents a general risk factor for the occurrence of venous thromboembolism (VTE). To date, however, it has been unclear whether IBD also increases the risk of the recurrence of thromboses (re-thromboses) and therefore work towards longer-term anticoagulation needs to be undertaken.

Thus, a team headed by Ao.Univ. Prof. Dr. Gottfried Novacek from the Department of Medicine III, Division of Gastroenterology and Hepatology conducted a relevant nationwide multicentre study in which 14 leading centres on IBD in Austria were involved. This trial was carried out in cooperation with the Department of Medicine I of MedUni Vienna, represented chiefly by Ao.Univ. Prof. Dr. Sabine Eichinger.
Within the framework of the study nearly 3,000 patients with IBD were examined following earlier thrombosis. Afterwards the rate of recurrent thrombosis in IBD patients was compared with the re-thrombosis rate of a large control group of the Department of Medicine I of MedUni Vienna (Austrian Study on Recurrent Venous Thromboembolism-AUREC, Principal Investigator Ao. Univ. Prof. Dr. Paul A. Kyrle).
Both the 86 IBD patients used for the comparison and the 1,255 controls had deep arm or leg thrombosis and/or lung embolism as their first thrombosis, which occurred spontaneously and were therefore not brought on by a malignant disease, surgery, trauma or pregnancy. The study showed that 5 years after completion of an anticoagulation treatment after the first thrombosis as many as 33% of IBD patients but only 22% of controls had suffered a recurrent thrombosis.

This result shows that patients with inflammatory bowel disease have not only a higher risk of thrombosis but also of recurrent thrombosis. In this way it was possible to confirm IBD as an independent risk factor for the development of thrombosis, which could have an impact on the physicians' therapy decision.

Says Novacek about the result of the study: "The study demonstrated for the first time that patients suffering from IBD run an increased risk of recurrent thrombosis and are therefore candidates for a prolonged anticoagulation therapy. It goes without saying that the possibly elevated risk of haemorrhage provoked by anticoagulation needs to be considered.“

» Publication in "Gastroenterology":
Inflammatory bowel disease is a risk factor for recurrent venous thromboembolism.
Novacek G, Weltermann A, Sobala A, Tilg H, Petritsch W, Reinisch W, Mayer A, Haas T, Kaser A, Feichtenschlager T, Fuchssteiner H, Knoflach P, Vogelsang H, Miehsler W, Platzer R, Tillinger W, Jaritz B, Schmid A, Blaha B, Dejaco C, Eichinger S.
Gastroenterology. 2010 Sep;139(3):779-87, 787.e1. Epub 2010 Jun 12. doi:10.1053/j.gastro.2010.05.026

Short biography:
and completed his specialisation training in internal medicine with the additional subject gastroenterology and hepatology. He qualified as a professor in 1999.
He also teaches gastroenterology and hepatology, in particular IBD, which is also his research focus, on which he has published a large number of publications.
Novacek is a member of many internal medical societies, including ECCO (European Crohn’s and Colitis Organisation), AGA (American Gastroenterology Association) and ÖGGH (Austrian Society of Gastroenterology and Hepatology), in addition he is the 2nd National Representative for Austria at ECCO.

*)Doz. Dr. Wolfgang Miehsler: Miehsler W, et al: Is inflammatory bowel disease an independent and disease specific risk factor for thromboembolism? Gut 2004;53:542-8.