Bleeding and thrombotic outcomes with oral anticoagulants in patients with inflammatory bowel disease and venous thromboembolism

Patients with inflammatory bowel disease (IBD) are at an increased risk of venous thromboembolism (VTE) and bleeding. We aimed to compare the risk of recurrent VTE and bleeding between direct oral anticoagulants (DOACs) and warfarin in patients with IBD and VTE. The study included adults with IBD and VTE who were newly prescribed DOACs or warfarin. The primary study outcomes were recurrent VTE and a composite of serious bleeding. We used Cox proportional hazard model after propensity score matching to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs). In a secondary analysis, we compared the risk of bleeding in patients on DOACs with IBD vs patients without IBD. Our matched IBD cohort of patients initiating oral anticoagulants comprised 2174 patients (1087 DOAC users and 1087 warfarin users). After propensity score matching, DOAC use (compared with warfarin) was associated with a lower risk of bleeding (HR, 0.59; 95% CI, 0.41-0.85) with no difference in the risk of recurrent VTE (HR, 0.82; 95% CI, 0.59-1.15). In the secondary analysis of patients with VTE who received DOACs, there was a twofold increase in the risk of bleeding in patients with IBD compared with those without IBD (HR, 1.99; 95% CI, 1.64-2.41). In patients with IBD and VTE, DOAC use was associated with a lower risk of bleeding compared with warfarin, without a significant difference in the risk of recurrent VTE. However, even with the use of DOACs, patients with IBD were twice as likely to experience serious bleeding as those without IBD, highlighting the importance of close monitoring.