Inflammatory bowel disease and thromboembolism

Table 5 Management of thromboembolic complications in inflammatory bowel disease patients

Primary prevention of thromboembolic complications
Ambulatory patients	Hospitalized patients
General measures	General measures
Physician awareness	Disease activity amelioration
Patient education	Early mobilization
Active disease treatment and remission maintenance	Judicious use of catheters
Recognition, elimination or modification of risk factors	Dehydration or nutritional deficiencies restoration
Steroid use	Medication modification
Smoking	Peri-operatively or in severely ill non-surgical patients
Oral contraceptives	Prophylactic anticoagulation (UH or LMHW)
Cardiovascular risk factors and other co-morbidities	Plus mechanical measures when increased thrombosis risk or mechanical measures only, when anticoagulation contraindicated with high bleeding risk
Long-distance flights
Post-hospitalization period
Compressive stockings?
Treatment of a thromboembolic event
Amelioration of disease activity
Hematology consultation and thrombophilia screening
Therapeutic anticoagulation - UH or LMWH
Thrombolysis - interventional radiology/surgical consultation
Secondary prevention of thromboembolic complications
After a first TE episode
Active disease - spontaneous event
Short term anticoagulation? - 3 to 6 mo
Plus anticoagulation during subsequent flares?
Inactive disease - spontaneous event
Long term anticoagulation?
Recurrent TE or inherited thrombophilia
Hematology consultation
Long term anticoagulation

UH: Unfractionated heparin; LMHW: Low molecular weight heparin.