INCREASED RISK OF VENOUS THROMBOEMBOLISM AMONG HOSPITALIZED INFLAMMATORY BOWEL DISEASE PATIENTS WITH EXPOSURE TO SEVERE ACURE RESPIRATORY SYNDROME CORONAVIRUS 2

ABSTRACT

Backgrounds Inflammatory bowel disease (IBD) is associated with a 2-to 3-fold increased risk of venous thromboembolism (VTE) and the risk is even higher in hospitalized IBD patients. Elevated risk of VTE has also been noted in patients with Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV- 2). In this study, we aimed to assess the risk of VTE among hospitalized IBD patients who had exposure to SARS-CoV-2 compared to those with no exposure. Methods All hospitalized patients with IBD including Crohn's disease (CD), ulcerative colitis (UC), and IBD-unclassified (IBD-U) across Banner Health in Arizona with and without COVID-19 between March 2020 to October 2021 were included in the study. Baseline clinical demographics, comorbidities, risk factors associated with VTE, and rate of VTE were compared between groups using Wilcoxon-rank sum test, chi-square and Fisher's Exact tests as appropriate. The impact of COVID-19 on VTE was quantified using regression analysis. Of note, UC and IBD-U patients were grouped together for analyses. Results The study cohort of 8,977 (4643 CD, 3960 UC, 374 IBD-U) IBD patients had a median age of 55 (interquartile range [IQR], 37-69) years. 7% (n= 631) of hospitalized IBD patients contracted COVID-19 and it was more frequent in Hispanics (17.6% vs 9.4%, p<0.001). Baseline characteristics were similar among IBD patients with and without COVID-19 except steroid use (24% vs 15%, p<0.001), obesity (19% vs 12%, p<0.001), chronic kidney disease (16% vs 10%, p<0.001), and heart failure (13 % vs 6%, p<0.001) which were more frequent in patients with COVID-19 (Table). VTE rate was higher among IBD patients with COVID-19 compared to those without [8.1% (n= 51) vs. 4.4% (n=367), P< 0.001]. This association was still significant after multivariate adjustment for age, sex, race, IBD type, tobacco use, obesity, and other comorbidities (OR 1.43. 95% CI 1.04-2.0, P =0.03). UC compared to CD, was associated with greater VTE risk (OR 1.38. 95% CI 1.10-1.7, P =0.002). Similar association was also noted with tobacco use, obesity, malignancy, chronic kidney disease, and heart failure. Despite higher rate of COVID-19 in Hispanics, there was no increased risk of VTE (OR 0.95, 95% CI 0.7-1.4, P =0.768) in this group (Figure). Conclusions COVID-19 is an independent risk factor for VTE in hospitalized patients with IBD. Our findings suggest not only the need for early detection of VTE but also aggressive pharmacological prophylaxis against VTE in this population. Further studies are needed to evaluate the benefit of post-discharge thromboprophylaxis in this cohort. (Table Presented) (Figure Presented)