Deep venous thrombosis after surgery for inflammatory bowel disease: Is standard dose low molecular weight heparin prophylaxis enough?

Marco Scarpa, Fabio Pilon, Vittorio Pengo, Giovanna Romanato, Cesare Ruffolo, Francesca Erroi, Bison Elisa, Mauro Frego, Elena Ossi, Enzo Manzato, Imerio Angriman

Research output: Contribution to journalArticle

21 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)1629-1636
Number of pages8
JournalWorld Journal of Surgery
Volume34
Issue number7
DOIs
Publication statusPublished - Jul 2010

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Low Molecular Weight Heparin
Inflammatory Bowel Diseases
Venous Thrombosis
Ulcerative Colitis
Immunoglobulin M
Colorectal Surgery
Crohn Disease
Doppler Ultrasonography
ROC Curve
Colorectal Neoplasms
Therapeutics
Multivariate Analysis
Randomized Controlled Trials
Color
Odds Ratio
Demography
Prospective Studies
Hemorrhage

ASJC Scopus subject areas

  • Surgery

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Deep venous thrombosis after surgery for inflammatory bowel disease : Is standard dose low molecular weight heparin prophylaxis enough? / Scarpa, Marco; Pilon, Fabio; Pengo, Vittorio; Romanato, Giovanna; Ruffolo, Cesare; Erroi, Francesca; Elisa, Bison; Frego, Mauro; Ossi, Elena; Manzato, Enzo; Angriman, Imerio.

In: World Journal of Surgery, Vol. 34, No. 7, 07.2010, p. 1629-1636.

Research output: Contribution to journalArticle

Scarpa, M, Pilon, F, Pengo, V, Romanato, G, Ruffolo, C, Erroi, F, Elisa, B, Frego, M, Ossi, E, Manzato, E & Angriman, I 2010, 'Deep venous thrombosis after surgery for inflammatory bowel disease: Is standard dose low molecular weight heparin prophylaxis enough?', World Journal of Surgery, vol. 34, no. 7, pp. 1629-1636. https://doi.org/10.1007/s00268-010-0490-8
Scarpa, Marco ; Pilon, Fabio ; Pengo, Vittorio ; Romanato, Giovanna ; Ruffolo, Cesare ; Erroi, Francesca ; Elisa, Bison ; Frego, Mauro ; Ossi, Elena ; Manzato, Enzo ; Angriman, Imerio. / Deep venous thrombosis after surgery for inflammatory bowel disease : Is standard dose low molecular weight heparin prophylaxis enough?. In: World Journal of Surgery. 2010 ; Vol. 34, No. 7. pp. 1629-1636.
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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.",
author = "Marco Scarpa and Fabio Pilon and Vittorio Pengo and Giovanna Romanato and Cesare Ruffolo and Francesca Erroi and Bison Elisa and Mauro Frego and Elena Ossi and Enzo Manzato and Imerio Angriman",
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T2 - Is standard dose low molecular weight heparin prophylaxis enough?

AU - Scarpa, Marco

AU - Pilon, Fabio

AU - Pengo, Vittorio

AU - Romanato, Giovanna

AU - Ruffolo, Cesare

AU - Erroi, Francesca

AU - Elisa, Bison

AU - Frego, Mauro

AU - Ossi, Elena

AU - Manzato, Enzo

AU - Angriman, Imerio

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N2 - 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.

AB - 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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