Effectiveness and Safety of Prophylactic Anticoagulation among Hospitalized Inflammatory Bowel Disease Patients.

Hospitalized inflammatory bowel disease (IBD) patients are at increased risk of venous thromboembolism (VTE). We aimed to evaluate the effectiveness and safety of prophylactic anticoagulation compared with no anticoagulation in hospitalized IBD patients. We conducted a retrospective cohort study using a hospital-based database. We included IBD patients who had a length of hospital stay ≥ 2 days from January 1, 2016, through December 31, 2019. We excluded patients who had other indications for anticoagulation, users of direct oral anticoagulants, warfarin, and therapeutic-intensity heparin, and patients admitted for surgery. We defined exposure to prophylactic anticoagulation using charge codes. The primary effectiveness outcome was VTE. The primary safety outcome was bleeding. We used propensity score matching to reduce potential differences between users and non-users of anticoagulants and Cox proportional-hazards regression to estimate adjusted hazard ratios (HRs) and 95% confidence intervals (CIs). The analysis included 65,314 matched IBD patients (n=28,157 for users of anticoagulants and n=28,157 for non-users). In the matched sample, prophylactic use of anticoagulants (vs. no use) was associated with a lower rate of VTE (HR, 0.62; 95% CI 0.41 to 0.93) and with no difference in the rate of bleeding (HR, 1.07; 95% CI 0.89 to 1.29). In this study of hospitalized IBD patients, prophylactic use of heparin was associated with a lower rate of VTE without increasing bleeding risk compared with no anticoagulation. Our results suggest potential benefits for prophylactic anticoagulation to reduce the burden of VTE in hospitalized patients with IBD.