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Deep Venous Thrombosis After Surgery for Inflammatory Bowel Disease: Is Standard Dose Low Molecular Weight Heparin Prophylaxis Enough?

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Abstract

Background

Inflammatory bowel disease (IBD) and colorectal surgery are risk factors for deep venous thrombosis (DVT). The aim of this prospective study was to evaluate the effectiveness of standardized prophylactic low molecular weight heparin (LMWH) therapy in patients who underwent surgery for ulcerative colitis (UC) and Crohn’s disease (CD).

Patients and methods

Since 1999 all patients operated on for colorectal diseases in our institute have received 4,000 IU/day LMWH from the day of operation to discharge. The complete series of patients who had major colorectal surgery from 1999 until 2006 were reviewed for overt DVT episodes. Furthermore, 60 consecutive patients who were admitted for surgery for IBD were prospectively enrolled in the 2004–2006 period. Each patient underwent venous color Doppler ultrasound scan at admission and at discharge. Demographic data, disease activity, and clotting parameters were collected. Data were analyzed with Spearman’s correlation test, multiple regression, and receiver operating characteristics (ROC) curves analysis.

Results

The rate of DVT in UC patients was significantly higher than in colorectal cancer patients (p = 0.009), and the odds ratio (OR) for postoperative DVT in UC patients was 7.4 (95% CI 1.4–44.4; p = 0.017). Female gender, UC diagnosis, active rectal bleeding, aPTT value, aCL IgM, aβ2 IgM, and pANCA levels significantly correlated with postoperative DVT. At multivariate analysis only aCL IgM levels were found to be independently associated with postoperative DVT (p = 0.05).

Conclusions

In conclusion, our study showed that prophylactic therapy with 4,000 IU/day LMWH was not completely effective for the prevention of postoperative DVT in patients with CD, and even less so in those with UC. In these patients, a more tailored prophylactic therapy should be considered, and further randomized controlled trials testing the effectiveness of different prophylactic protocols would be advisable. Furthermore, aCL IgM serum levels might be helpful in identifying IBD patients who are at higher risk of postoperative DVT.

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Acknowledgments

The authors are grateful to Raffaella Marin and Silvia Zannoni (Clinica Medica I, University of Padova, Italy) for assistance in preserving serum samples. Teresa Filosa, Matteo Bertin, and Silvia Basato (Clinica Chirurgica I, University of Padova, Italy) who retrieved the patient histories, are also gratefully acknowledged. This work was funded, in part, by the MIUR grant ex 60%.

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Authors and Affiliations

  1. Department of Oncological Surgery, Veneto Oncological Institute (IOV-IRCCS), Via Gattamelata 64, 35128, Padova, Italy

    Marco Scarpa

  2. U.O.A Chirurgia Vascolare, Ospedale “San Bortolo”, Vicenza, Italy

    Fabio Pilon

  3. Thrombosis Center, Department of Cardio-Thoracic and Vascular Sciences, University of Padova, Padova, Italy

    Vittorio Pengo & Bison Elisa

  4. Institute of Neurosciences, Aging Section, National Council for Research (CNR), Padova, Italy

    Giovanna Romanato

  5. Clinica Medica I, Department of Medical and Surgical Sciences, University of Padova, Padova, Italy

    Giovanna Romanato, Elena Ossi & Enzo Manzato

  6. Clinica Chirurgica I, Department of Surgical and Gastroenterological Sciences, University of Padova, Padova, Italy

    Cesare Ruffolo, Francesca Erroi, Mauro Frego & Imerio Angriman

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  1. Marco Scarpa
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  2. Fabio Pilon
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Corresponding author

Correspondence to Marco Scarpa.

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Scarpa, M., Pilon, F., Pengo, V. et al. Deep Venous Thrombosis After Surgery for Inflammatory Bowel Disease: Is Standard Dose Low Molecular Weight Heparin Prophylaxis Enough?. World J Surg 34, 1629–1636 (2010). https://doi.org/10.1007/s00268-010-0490-8

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  • DOI: https://doi.org/10.1007/s00268-010-0490-8

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