Health

COVID Led to Higher Clot Risk in Veterans With IBD

Older men with inflammatory bowel disease (IBD) had a higher chance of developing venous thromboembolism (VTE) after contracting COVID-19, researchers found in a case crossover study of veterans.

For IBD patients in the VA health system, SARS-CoV-2 infection was associated with an eight-fold increased likelihood of developing VTE (OR 8.15, 95% CI 4.34-15.30, P<0.001), reported Nabeel Khan, MD, and colleagues from the University of Pennsylvania in Philadelphia.

However, when limited to patients on chronic anticoagulant medications, there was no significant association between COVID-19 and VTE in this group (OR 0.63, 95% CI 0.08-5.15, P=0.66), the authors wrote in Gastroenterology.

One small study from pre-pandemic times suggested that IBD patients are at a two- to three-fold increased risk for developing VTE compared with the general population. And other research has demonstrated that the risk for VTE is even greater (by 16 fold) for non-hospitalized patients who present with active IBD. Meta-analysis data showed VTE has also been associated with a higher mortality risk for patients in the hospital (RR 1.31, 95% CI 0.99-1.74, P=0.06).

For patients hospitalized with severe COVID-19, but who do not have confirmed or suspected VTE, the American Society of Hematology recommends use of anticoagulation as thromboprophylaxis.

However, no study has evaluated the risk of VTE for IBD patients who contract COVID-19. The pathogenesis of VTE is complex and multifactorial in IBD, which can be further complicated by a COVID-19 infection, Khan and co-authors said.

“In patients with infections such as COVID-19, endothelial dysfunction caused by the infectious process increases thrombin production and terminates fibrinolysis, which in turn promotes a hypercoagulable state,” they wrote. “Although these mechanisms cannot be completely explained by traditional VTE risk factors, it stands to reason that contracting SARS-CoV-2 infection would confer an additional risk on top of the already elevated risk in patients with IBD.”

For their study, the researchers examined data on IBD patients from the VA healthcare system who reported a VTE event from April 1, 2020 to March 30, 2021.

Overall, there were 428 participants included in this study, with an average age of 69. Nearly all were men and about 80% were white, with 54% having a diagnosis of ulcerative colitis and 46% having Crohn’s disease. Half of the patients were taking 5-aminosalicylic acid.

The most common pre-existing conditions among participants were hypertension (58%), diabetes mellitus (31%), and arrhythmia (20%). Chronic anticoagulant use was reported in 31% of patients.

There were 13.6% of participants who contracted COVID-19. Among these, 21 contracted the virus within 30 days before experiencing VTE. Furthermore, there were 5.1% of IBD patients hospitalized due to COVID-19 infection.

The authors found a substantially higher VTE risk in patients who were not taking anticoagulant medications prior to COVID-19 infection (OR 14.31, 95% CI 6.90-29.66, P<0.001).

“Our data suggest that IBD patients who contract SARS-CoV-2 have a substantially increased risk of VTE and may therefore benefit from prophylaxis,” Khan and co-authors stated.

Limitations of this study include its retrospective design and the exclusion of VTE events diagnosed outside the VA health system. This sole data source may have introduced bias and a larger, more diverse patient population could have boosted the accuracy of the findings, the authors said.

  • Zaina Hamza is a staff writer for MedPage Today, covering Gastroenterology and Infectious disease. She is based in Chicago.

Disclosures

Study support primarily came from Pfizer and an award from the American College of Gastroenterology.

Khan disclosed funding from Takeda Pharmaceuticals, Pfizer, Samsung Bioepis, and Luitpold. One co-author disclosed support from AbbVie, Merck, Takeda, J&J, Lilly, Janssen, was a member of the data Safety Monitoring Boards of UCB, Pfizer, Gilead, and accepted support from Nestle Health Science and Takeda.

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