From Guardian.co.uk:

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People with inflammatory bowel diseases like Crohn’s disease and ulcerative colitis have a higher risk of getting a blood clot in a vein (DVT), new research shows. Doctors recommend that people with these illnesses be aware of the symptoms of DVT, so they can get help urgently if needed.

What do we know already?

People often associate DVT with long-distance flights, but there are other situations that can leave people vulnerable to a blood clot. People with reduced mobility have a higher risk, and people going into hospital for surgery often need treatment to guard against clots. It’s important to take DVT seriously, since a clot can travel to the lungs and cause breathing difficulties. About 6 in 100 people who get DVT die.

Previous research has shown that people with inflammatory bowel disease are more likely to get DVT than healthy people. However, we don’t know when people are most vulnerable, or whether the risks are big enough to justify treatment. A new study has tried to answer these questions.

Researchers looked at the GP records of nearly 14,000 people with Crohn’s disease and ulcerative colitis. Together, these illnesses are known as inflammatory bowel disease, and they affect tens of thousands of people in the UK. The researchers also looked at nearly 72,000 people without bowel disease, to act as a comparison group.

What does the new study say?

People with inflammatory bowel disease were more likely to get DVT than people in the comparison group. The biggest risk was for people having a flare-up of bowel disease that was bad enough to need steroid treatment.

Over the course of a year, the researchers found that 2.6 in 1,000 people with bowel disease got DVT, compared with just 0.6 in 1,000 people from the comparison group.

Unsurprisingly, people were more likely to get a DVT if they spent time in hospital being treated for a flare-up of bowel disease. Over a year, 37.5 in 1,000 of these people had DVT, compared with 13.9 in 1,000 people hospitalised for other reasons.

Outside hospital, the risk of getting DVT during a flare-up of symptoms was 6.4 in 1,000 people per year, which is much higher than for people without bowel disease.

How reliable are the findings?

The study was done by looking at GP records, so is only as accurate as the records that were made in the first place. It might also be that doctors check people for DVT more thoroughly if they have bowel disease, because this risk has been known for a while. That might mean more bowel disease patients have their DVT diagnosed, making it look as if the risk is higher than it really is.

Where does the study come from?

The researchers were based in Nottingham, and their study was published by The Lancet. Funding came from a charity called the National Association for Colitis and Crohn’s Disease.

What does this mean for me?

The study used records kept by GPs in the UK, so the results are likely to apply to people living in the UK now. Treatments can help protect against DVT, but it’s hard to say whether they are beneficial outside high-risk settings like a hospital. For example, drugs to prevent blood clots can cause bleeding as a side effect, so we need more research to know whether the benefits outweigh the risks.

What should I do now?

If you have Crohn’s disease or ulcerative colitis and you’re hospitalised or having surgery, talk to your doctor about treatments to prevent DVT.

Outside hospital, it’s a good idea to know the signs and symptoms of DVT, so you can get help quickly if you think you might have had one. This is especially important if your bowel disease is getting worse. Clots often block a blood vessel in the leg. Symptoms include:

• Swelling or pain in your calf or thigh
• Your leg feeling hot or turning red.

Blood clots in your leg can travel to your lungs and cause breathlessness or chest pain. This is a dangerous emergency, so if this happens, call 999 straight away.

From:

Grainge MJ, West J, Card TR. Venous thromboembolism during active disease and remission in inflammatory bowel disease: a cohort study. The Lancet. Published online 9 February 2010.

http://www.guardian.co.uk/lifeandstyle/besttreatments/2010/feb/09/bowel-disease-patients-should-be-aware-of-dvt-risk

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