Venous thromboembolism in chronic gastrointestinal disorders

ABSTRACT

Introduction

Chronic gastrointestinal disorders (including autoimmune gastritis, celiac disease, inflammatory bowel disease, and diverticular disease) are highly prevalent disorders, that may be associated with unpredictable, life-threatening complications, such as thromboembolic events. Venous thromboembolism (VTE) is one of the major causes of morbidity and mortality worldwide. Several conditions, including cancer, major trauma, surgery, prolonged immobilization, are well-established risk factors for VTE. Over the past decade, chronic inflammation has also been identified as an independent risk factor for VTE due to the prothrombotic effects of inflammatory cytokines and oxidative stress on the coagulation cascade. Other several mechanisms were shown to be associated with a higher incidence of VTE in patients with gastrointestinal disorders.

Areas covered

We critically discuss the latest insights into the mechanisms responsible for thromboembolic manifestations in chronic gastrointestinal disorders, also focusing on the recognition of risk factors and treatment.

Expert opinion

The occurrence of thrombotic complications is underestimated in patients with chronic gastrointestinal disorders. Identifying potential risk factors and concomitant predisposing conditions and to prevent VTE and guide treatment require a multidisciplinary approach, and this is critically important for clinicians, in order to provide the best care for such patients.

KEYWORDS:

• Autoimmunity
• coagulation
• inflammation
• platelets

Article highlights

• The risk of venous thromboembolism is often underestimated in chronic gastrointestinal disorders and there is poor consensus on management and treatment of such complications

• Evaluation of venous thromboembolism risk in patients with chronic gastrointestinal disorders requires a multidisciplinary approach

• Various mechanisms including chronic inflammation, platelet activation, autoimmunity and hyperhomocysteinemia are responsible for the occurrence of thrombotic complications in patients with chronic gastrointestinal disorders

• Spleen hypofunction may contribute to the development of venous thromboembolism and its role needs to be further assessed in patients with chronic gastrointestinal disorders

Acknowledgments

Federica Melazzini and Marco Vincenzo Lenti are grateful to the University of Pavia and San Matteo Hospital Foundation for supporting their research work.

Author contributions

All authors participated in the drafting of the paper, made critical revision to the manuscript for important intellectual content, and provided approval of the final submitted version.

Declaration of interests

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.