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Preoperative prevalence and risk factors of deep-vein thrombosis in Japanese surgical patients with ulcerative colitis: a retrospective investigational study

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Abstract

Purpose

The purpose of this study was to clarify the perioperative deep-vein thrombosis (DVT) prevalence and its risk factors in surgical ulcerative colitis (UC) patients by comparing the results with those in surgical colorectal cancer (CRC) patients at a high risk of perioperative venous thrombosis.

Methods

This retrospective, observational study included patients who underwent surgery for UC or CRC between January 2013 and October 2019. Consecutive surgical patients with a positive D-dimer assay result (≥ 1.0 µg/ml) underwent lower-extremity venous ultrasonography. The prevalence and risk factors for preoperative DVT were examined in UC patients.

Results

A total of 101 UC patients and 593 CRC patients were deemed eligible. Among the D-dimer positive cases, there were no significant differences between the two groups in the preoperative DVT prevalence (UC: 21.8% vs. CRC: 28.8%, p = 0.151), distal type (18.8% vs. 27.2%, p = 0.086), or proximal type (5.9% vs. 4.2%, p = 0.434). Furthermore, multivariate analyses showed that an older age, overweight status, poor ASA status, and a high preoperative dose of steroid were independent risk factors for preoperative DVT in UC surgical patients.

Conclusions

The risk of perioperative thrombosis in UC patients was considered similar to that in CRC, so active thromboprophylaxis should be administered to UC patients while paying attention to bleeding.

Trial registration

This study was registered with the Japanese Clinical Trials Registry as UMIN000042004 (http://www.umin.ac.jp/ctr/index.htm).

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References

  1. Bernstein CN, Blanchard JF, Houston DS, Wajdaq ZA. The incidence of deep venous thrombosis and pulmonary embolism among patients with inflammatory bowel disease: a population-based cohort study. Thromb Haemost. 2001;85(3):430–4.

    Article  CAS  Google Scholar 

  2. Grainge MJ, West J, Card TR. Venous thromboembolism during active disease and remission in inflammatory bowel disease: a cohort study. Lancet. 2010;375(9715):657–63. https://doi.org/10.1016/S0140-6736(09)61963-2.

    Article  PubMed  Google Scholar 

  3. Huerta C, Johansson S, Wallander MA, García Rodríguez LA. Risk factors and short-term mortality of venous thromboembolism diagnosed in the primary care setting in the United Kingdom. Arch Intern Med. 2007;167(9):935–43. https://doi.org/10.1001/archinte.167.9.935.

    Article  PubMed  Google Scholar 

  4. Nguyen GC, Sam J. Rising prevalence of venous thromboembolism and its impact on mortality among hospitalized inflammatory bowel disease patients. Am J Gastroenterol. 2008;103(9):2272–80. https://doi.org/10.1111/j.1572-0241.2008.02052.x.

    Article  PubMed  Google Scholar 

  5. Murthy SK, Nguyen GC. Venous thromboembolism in inflammatory bowel disease: an epidemiological review. Am J Gastroenterol. 2011;106(4):713–8. https://doi.org/10.1038/ajg.2011.53.

    Article  PubMed  Google Scholar 

  6. Novacek G, Weltermann A, Sobala A, Tilg H, Petritsch W, Reinisch W, et al. Inflammatory bowel disease is a risk factor for recurrent venous thromboembolism. Gastroenterology. 2010;139(3):779-787e1. https://doi.org/10.1053/j.gastro.2010.05.026.

    Article  PubMed  Google Scholar 

  7. Masaki T, Kishiki T, Kojima K, Asou N, Beniya A, Matsuoka H. Recent trends (2016–2017) in the treatment of inflammatory bowel disease. Ann Gastroenterol Surg. 2018;2(4):282–8. https://doi.org/10.1002/ags3.12177.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Hata T, Ikeda M, Miyata H, Nomura M, Gotoh M, Sakon M, et al. Frequency and risk factors for venous thromboembolism after gastroenterological surgery based on the Japanese national clinical database (516 217 cases). Ann Gastroenterol Surg. 2019;3(5):534–43. https://doi.org/10.1002/ags3.12275.

    Article  PubMed  PubMed Central  Google Scholar 

  9. JCS Joint Working Group. Guidelines for the diagnosis, treatment and prevention of pulmonary thromboembolism and deep vein thrombosis (JCS 2009). Circ J. 2011;75(5):1258–81. https://doi.org/10.1253/circj.cj-88-0010.

    Article  Google Scholar 

  10. Nakagawa K, Watanabe J, Suwa Y, Suzuki S, Ishibe A, Ota M, et al. Clinical analysis of preoperative deep vein thrombosis risk factors in patients with colorectal cancer: retrospective observational study. Ann Gastroenterol Surg. 2019;3(4):451–8. https://doi.org/10.1002/ags3.12256.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Fünfsinn N, Caliezi C, Biasiutti FD, Korte W, Z’Brun A, Baumgartner I, et al. Rapid D-dimer testing and pre-test clinical probability in the exclusion of deep venous thrombosis in symptomatic outpatients. Blood Coagul Fibrinolysis. 2001;12(3):165–70. https://doi.org/10.1097/00001721-200104000-00001.

    Article  PubMed  Google Scholar 

  12. Legnani C, Pancani C, Palareti G, Guazzaloca G, Coccheri S. Contribution of a new, rapid, quantitative and automated method for D-dimer measurement to exclude deep vein thrombosis in symptomatic outpatients. Blood Coagul Fibrinolysis. 1999;10(2):69–74. https://doi.org/10.1097/00001721-199903000-00002.

    Article  CAS  PubMed  Google Scholar 

  13. van der Graaf F, van den Borne H, van der Kolk M, de Wild PJ, Janssen GW, van Uum SH. Exclusion of deep venous thrombosis with D-dimer testing–comparison of 13 D-dimer methods in 99 outpatients suspected of deep venous thrombosis using venography as reference standard. Thromb Haemost. 2000;83(2):191–8.

    Article  Google Scholar 

  14. White RH, McGahan JP, Daschbach MM, Hartling RP. Diagnosis of deep-vein thrombosis using duplex ultrasound. Ann Intern Med. 1989;111(4):297–304. https://doi.org/10.7326/0003-4819-111-4-297.

    Article  CAS  PubMed  Google Scholar 

  15. Becker DM, Philbrick JT, Abbitt PL. Real-time ultrasonography for the diagnosis of lower extremity deep venous thrombosis. The wave of the future? Arch Intern Med. 1989;149(8):1731–4.

    Article  CAS  Google Scholar 

  16. Cogo A, Lensing AW, Wells P, Prandoni P, Büller HR. Noninvasive objective tests for the diagnosis of clinically suspected deep-vein thrombosis. Haemostasis. 1995;25(1–2):27–39. https://doi.org/10.1159/000217141.

    Article  CAS  PubMed  Google Scholar 

  17. Wang JY, Terdiman JP, Vittinghoff E, Minichiello T, Varma MG. Hospitalized ulcerative colitis patients have an elevated risk of thromboembolic events. World J Gastroenterol. 2009;15(8):927–35. https://doi.org/10.3748/wjg.15.927.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Wada T, Fujiwara H, Morita S, Fukagawa T, Katai H. Incidence of and risk factors for preoperative deep venous thrombosis in patients undergoing gastric cancer surgery. Gastric Cancer. 2017;20(5):872–7. https://doi.org/10.1007/s10120-017-0690-0.

    Article  PubMed  Google Scholar 

  19. Kanda Y. Investigation of the freely available easy-to-use software ‘EZR’ for medical statistics. Bone Marrow Transpl. 2013;48(3):452–8. https://doi.org/10.1038/bmt.2012.244.

    Article  CAS  Google Scholar 

  20. Guyatt GH, Eikelboom JW, Gould MK, Garcia DA, Crowther M, Murad MH, et al. Approach to outcome measurement in the prevention of thrombosis in surgical and medical patients: antithrombotic therapy and prevention of thrombosis, 9th ed: American college of chest physicians evidence-based clinical practice guidelines. Chest. 2012;141(2 Suppl):e185S – e194. https://doi.org/10.1378/chest.11-2289.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Okada S, Hata K, Yokoyama T, Sasaki K, Kawai K, Tanaka T, et al. Postoperative bleeding after subtotal colectomy in two patients with severe ulcerative colitis. J Dig Dis. 2018;19(10):641–5. https://doi.org/10.1111/1751-2980.12658.

    Article  PubMed  Google Scholar 

  22. Bell RL, Seymour NE. Laparoscopic treatment of fulminant ulcerative colitis. Surg Endosc. 2002;16(12):1778–82. https://doi.org/10.1007/s00464-001-8300-x.

    Article  CAS  PubMed  Google Scholar 

  23. WøJdemann M, Wettergren A, Hartvigsen A, MyrhøJ T, Svendsen LB, BuLow S. Closure of rectal stump after colectomy for acute colitis. Int J Colorectal Dis. 1995;10(4):197–9. https://doi.org/10.1007/BF00346218.

    Article  PubMed  Google Scholar 

  24. Robert JH, Sachar DB, Aufses AH Jr, Greenstein AJ. Management of severe hemorrhage in ulcerative colitis. Am J Surg. 1990;159(6):550–5. https://doi.org/10.1016/s0002-9610(06)80064-4.

    Article  CAS  PubMed  Google Scholar 

  25. Tanizawa Y, Bando E, Kawamura T, Tokunaga M, Makuuchi R, Iida K, et al. Prevalence of deep venous thrombosis detected by ultrasonography before surgery in patients with gastric cancer: a retrospective study of 1140 consecutive patients. Gastric Cancer. 2017;20:878–86. https://doi.org/10.1007/s10120-016-0677-2.

    Article  PubMed  Google Scholar 

  26. Comfere TB, Sprung J, Case KA, Dye PT, Johnson JL, Hall BA, et al. Predictors of mortality following symptomatic pulmonary embolism in patients undergoing noncardiac surgery. Can J Anaesth. 2007;54(8):634–41. https://doi.org/10.1007/BF03022957.

    Article  PubMed  Google Scholar 

  27. Nicolaides AN, Fareed J, Kakkar AK, Comerota AJ, Goldhaber SZ, Hull R, et al. Prevention and treatment of venous thromboembolism–International consensus statement. Int Angiol. 2013;32(2):111–260.

    CAS  PubMed  Google Scholar 

  28. Ando K, Fujiya M, Nomura Y, et al. The incidence and risk factors of venous thromboembolism in Japanese inpatients with inflammatory bowel disease: a retrospective cohort study. Intest Res. 2018;16(3):416–25. https://doi.org/10.5217/ir.2018.16.3.416.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Donati MB, Poggi A. Malignancy and haemostasis. Bri J Haematol. 1980;44(2):173–82. https://doi.org/10.1111/j.1365-2141.1980.tb01199.x.

    Article  CAS  Google Scholar 

  30. Lam A, Borda IT, Inwood MJ, Thomson S. Coagulation studies in ulcerative colitis and Crohn’s disease. Gastroenterology. 1975;68(2):245–51.

    Article  CAS  Google Scholar 

  31. Anderson R, Kaariainen IT, Hanauer SB. Protein-losing enteropathy and massive pulmonary embolism in a patient with giant inflammatory polyposis and quiescent ulcerative colitis. Am J Med. 1996;101(3):323–5. https://doi.org/10.1016/S0002-9343(96)00201-X.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Inflammatory Bowel Disease Center, Yokohama City University Medical Center, 4-57, Urafune-Cho, Minami-Ku, Yokohama, 232-0024, Japan

    Hiroki Ohya, Hideaki Kimura & Reiko Kunisaki

  2. Department of Surgery, Gastroenterological Center, Yokohama City University Medical Center, 4-57, Urafune-Cho, Minami-Ku, Yokohama, 232-0024, Japan

    Jun Watanabe, Yusuke Suwa & Chikara Kunisaki

  3. Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, 3-9, Fukuura, Kanazawa-ku, Yokohama, 236-0024, Japan

    Kazuya Nakagawa, Mayumi Ozawa, Atsushi Ishibe & Itaru Endo

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  1. Hiroki Ohya
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  2. Hideaki Kimura
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Correspondence to Hideaki Kimura.

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Ohya, H., Kimura, H., Watanabe, J. et al. Preoperative prevalence and risk factors of deep-vein thrombosis in Japanese surgical patients with ulcerative colitis: a retrospective investigational study. Surg Today 52, 251–259 (2022). https://doi.org/10.1007/s00595-021-02335-0

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  • DOI: https://doi.org/10.1007/s00595-021-02335-0

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