Patients with IBD who catch COVID-19 have high clot risk, study finds
Infection with SARS-CoV-2 was associated with an eightfold increase in the risk of venous thromboembolism among patients with inflammatory bowel disease (IBD), but the risk was mitigated by chronic anticoagulation, according to a retrospective study.
COVID-19 poses a particular risk of venous thromboembolism (VTE) for patients with inflammatory bowel disease (IBD), a recent study of Veterans Affairs patients found.
The researchers conducted a retrospective case crossover study to identify patients who had IBD prior to March 1, 2020, and developed a VTE between April 1, 2020, and March 30, 2021. They obtained data on demographics, medication use, and comorbidities for each patient, as well as dates of SARS-CoV-2 infection. The results were published as a short survey by Gastroenterology on June 14.
A total of 428 patients with IBD had a VTE. The median age of the cohort was 69 years (93.9% men; 79.4% White). More than half of patients had ulcerative colitis, and the majority were being treated with 5-aminosalicylic acid alone (49.8%) or anti-tumor necrosis factor agents alone (15.7%). During the study period, there were 58 SARS-CoV-2 infections, 21 of which occurred in the 30 days prior to VTE. After adjustment for recent hospitalization and steroid exposure, SARS-CoV-2 infection was strongly associated with VTE (odds ratio [OR], 8.15 [95% CI, 4.34 to 15.30]; P<0.001). However, in patients on chronic anticoagulation, there was no association between SARS-CoV-2 and VTE (OR, 0.63 [95% CI, 0.08 to 5.15]; P=0.66).
The study authors noted that prior research has shown that patients with IBD have significantly increased risk of VTE and that COVID-19 is associated with clots; thus, “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.” The finding that patients on chronic anticoagulation showed no increase in VTE risk with COVID-19 infection is important, they added. “This suggests that there may be a possible role for VTE pharmaco-prophylaxis especially among high-risk IBD patients who contract SARS-CoV-2,” the authors said.
Another recent study of patients with IBD found that the Pfizer-BioNTech and Moderna COVID-19 vaccines appeared to be safe and effective in this population. The study, also published as a short survey by Gastroenterology on June 14, looked at 864,575 vaccinated patients, 5,562 who had a prior diagnosis of IBD (ulcerative colitis, n=2,933; Crohn's disease, n=2,629). Fewer than 10 patients with IBD had an immediate reaction to the vaccine, 113 had new instances of the CDC-reported adverse events of special interest, and 19 were diagnosed with COVID-19 after vaccination. The rates of these outcomes did not differ significantly from those in patients without IBD. “Our study findings are reassuring and support the continued use of these vaccines in patients with IBD,” the authors said.