Intest Res.  2023 Jul;21(3):318-327. 10.5217/ir.2022.00116.

Risk of venous thromboembolism with a central venous catheter in hospitalized Japanese patients with inflammatory bowel disease: a propensity score-matched cohort study

• Aoki Y
• Kiyohara H
• Mikami Y
• Nanki K
• Kawaguchi T
• Yoshimatsu Y
• Sugimoto S
• Sujino T
• Takabayashi K
• Hosoe N
• Ogata H
• Iwao Y
• Kanai T

• KMID: 2544755
• DOI: http://doi.org/10.5217/ir.2022.00116

Abstract

Background/Aims
Thromboprophylaxis is recommended for hospitalized patients with inflammatory bowel disease (IBD) in Western countries, although it is selectively administered to high-risk patients in East Asia. A central venous catheter (CVC) is commonly placed in patients with IBD. Although CVC placement is considered a risk factor for venous thromboembolism (VTE), the degree of increased risk in patients with IBD is uncertain. This study aimed to identify the risk of VTE with CVC placement in hospitalized Japanese patients with IBD without thromboprophylaxis.
Methods
This retrospective cohort study included patients with ulcerative colitis or Crohn’s disease who were admitted for disease flares at Keio University Hospital between January 2016 and December 2020. Patients who already had thrombosis or were administered any antithrombotic treatment on admission were excluded. VTE development during the hospitalization was surveyed, and VTE risk associated with CVC indwelling was estimated using propensity score matching and inverse probability of treatment weighting analyses.
Results
Altogether, 497 hospitalized patients with IBD (ulcerative colitis, 327; Crohn’s disease, 170) were enrolled. VTE developed in 9.30% (12/129) of catheterized patients and in 0.82% (3/368) of non-catheterized patients. The propensity score matching yielded 127 matched pairs of patients. The catheterized group demonstrated higher odds for VTE than the non-catheterized group (odds ratio, 13.15; 95% confidence interval, 1.68–102.70). A similar result was obtained in the inverse probability of treatment weighting analysis (odds ratio, 11.02; 95% confidence interval, 2.64–46.10).
Conclusions
CVC placement is a major risk factor for VTE among hospitalized Japanese patients with IBD without thromboprophylaxis.

Keyword

Venous thromboembolism; Central venous catheter; Inflammatory bowel disease; Asia; Thromboprophylaxis

Figure

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  Fig. 1. Study flow diagram. Patients with IBD (n=846) were enrolled in this study. Of these, 497 patients were included in the study. They were divided into 2 groups: catheterized and non-catheterized. There were 127 matched pairs after propensity score-based matching. UC, ulcerative colitis; CD, Crohn’s disease; IBD, inflammatory bowel disease; CVC, central venous catheter.

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  Fig. 2. Distribution of propensity scores and variability of covariates. (A) Distribution of propensity scores in the catheterized (above) and non-catheterized (below) groups. (B) The covariates used for the estimation of the propensity scores and the bias across the covariates before and after matching based on propensity scores. CRP, C-reactive protein; WBC, white blood cell; VTE, venous thromboembolism.

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