Physicians' perceptions of risks and practices in venous thromboembolism prophylaxis in inflammatory bowel disease

Dig Dis Sci. 2013 Jan;58(1):46-52. doi: 10.1007/s10620-012-2435-6. Epub 2012 Oct 7.

Abstract

Background: Hospitalized inflammatory bowel disease (IBD) patients are at a higher risk of venous thromboembolism (VTE).

Aims: We aimed to determine perceptions of VTE risks and self-reported practices regarding VTE prophylaxis in hospitalized IBD patients among American gastroenterologists.

Methods: Gastroenterologists who were members of the American Gastroenterological Association (AGA) and cared for IBD patients in the preceding 12 months were included. A survey assessed physicians' perceptions of VTE risks and their practices regarding VTE prophylaxis among IBD inpatients and other factors that may influence the decision to provide prophylaxis.

Results: A total of 135 eligible gastroenterologists responded to the survey, 77 % of whom practiced in academic settings. Most physicians (84%) reported having had IBD patients develop VTE. Only 67% cared for IBD patients in hospitals that had protocols for VTE prophylaxis, and 45% were aware of any published guidelines for VTE prophylaxis in hospitalized IBD patients. While only 7% believed that any rectal bleeding was a contraindication to VTE chemoprophylaxis in hospitalized IBD patients with flares, 14% never administered prophylaxis to IBD inpatients. A significant number of respondents felt that hospitalized IBD patients who were ambulatory (24%) or in remission (28%) did not require VTE prophylaxis. There was wide variation on recommendations for duration of anticoagulation for a first unprovoked VTE in an IBD patient.

Conclusions: There is significant variation in reported practices for VTE prophylaxis in IBD patients among gastroenterologists. A more standardized approach to VTE prophylaxis should be implemented to improve health outcomes for IBD inpatients.

MeSH terms

  • Anticoagulants / therapeutic use*
  • Data Collection
  • Gastroenterology
  • Hospitalization
  • Humans
  • Inflammatory Bowel Diseases / complications*
  • Inflammatory Bowel Diseases / epidemiology
  • Practice Patterns, Physicians'
  • Risk Factors
  • Surveys and Questionnaires
  • Treatment Outcome
  • United States
  • Venous Thromboembolism / epidemiology
  • Venous Thromboembolism / prevention & control*

Substances

  • Anticoagulants