The Risk of Upper Gastrointestinal Bleeding and Coagulopathy in IBD Patients with Cirrhosis

Introduction : In cirrhotic patients, systemic inflammation disrupts the delicate balance of hemostatic variables, akin to what occurs in inflammatory bowel disease (IBD), potentially resulting in a shift towards either a procoagulant or anticoagulant state. Current guidelines advocating for anticoagulation use in hospitalized IBD patients lack strong evidence, and there is a notable absence of guidelines tailored specifically for those with underlying cirrhosis. This study seeks to explore how underlying cirrhosis impacts the risk of coagulopathy and gastrointestinal bleeding in IBD patients, aiming to provide insights for making well-informed decisions regarding anticoagulation therapy. Patients and Methods : Utilizing the National Inpatient Sample database, we identified hospitalizations with a primary or secondary diagnosis of IBD and cirrhosis based on ICD-10 codes from 2016 to 2020. This retrospective cohort study excluded pregnant women, patients requiring chronic anticoagulation, and those with malignancies to mitigate confounding. A meticulous 1:1 matching for significant comorbidities between cohorts was performed. Primary outcome studied is incidence of upper GI bleed, secondary outcomes include mortality, venous thromboembolism, length of stay. Results : Of the total IBD patients, 5,375 had cirrhosis. Following 1:1 matching, both the cirrhotic and non-cirrhotic groups comprised 4,195 patients. In the matched cohorts, IBD patients with cirrhosis exhibited an increased risk of upper gastrointestinal bleeding (RR-3.60, p < 0.0001) and mortality (RR-2.78, p < 0.002), while there was no significant difference in venous thromboembolism (VTE) events (RR-1.70, p-0.446). Length of stay did not significantly differ between the groups. Conclusion : This study uncovers a markedly elevated incidence of upper gastrointestinal bleeding among IBD patients with cirrhosis. Our results underscore the importance of diligent monitoring and close follow-up for individuals with both conditions. The efficacy of anticoagulation in preventing thromboembolic events remains uncertain in these patients, given the heightened propensity for bleeding observed in our study among those with IBD and cirrhosis. Future randomized clinical trials are warranted to investigate the effect of anticoagulation in this population, taking into account the varying severity of underlying cirrhosis.