Characteristics of Patients with Inflammatory Bowel Disease and Impact on Outcomes Following Heparin-Induced Thrombocytopenia: A 5-Year Nationwide Analysis
Authors: Saowapa Sakditad , Polpichai Natchaya , Chaisidhivej Natapat , Tanariyakul Manasawee , Wannaphut Chalothorn , Danpanichkul Pojsakorn , Garcia Pleitez Hector , Bernal Diego Olavarria , Wattanachayakul Phuuwadith , Ponvilawan Ben , Siladech Pharit , Tijani Lukman 
Published: December 2024

Background: Heparin-induced thrombocytopenia (HIT) is a significant complication of heparin therapy, characterized by thrombocytopenia and an increased risk of thrombosis. The impact of inflammatory bowel disease (IBD) on the outcomes of patients with HIT is not well understood. This study aims to evaluate the characteristics of patients with IBD and assess the impact of IBD on outcomes following HIT.

Methods: This retrospective study utilized data from the National Inpatient Sample (NIS) between 2016 and 2020. Patients diagnosed with HIT were identified using the ICD-10 code “D7582” and categorized based on the presence of IBD. Hospitalization characteristics, comorbidities, and outcomes were compared between patients with and without IBD. Primary outcomes included in-hospital mortality, length of stay (LOS), and total hospital charges (THC). Secondary outcomes focused on specific hospital outcomes. Linear and multivariate logistic regression analyses were performed, with p-values ≤ 0.05 indicating statistical significance.

Results: A total of 72,934 patients with HIT hospitalizations between 2016 and 2020 were identified, of which 880 had IBD. Among the IBD group, 545 patients (61.93%) had Crohn's disease, and 335 patients (38.06%) had ulcerative colitis. The cohort with IBD was younger (mean age 59.05 vs. 64.15 years; p &lt; 0.001), more likely to be female (55.11% vs. 44.89%; p = 0.03), and predominantly Caucasian (33.52%; p &lt; 0.001). They were also more likely to be from the Midwest (31.25%; p = 0.03) and had a higher Charlson Comorbidity Index (CCI) &gt; 3 (43.18%; p &lt; 0.001). HIT patients with IBD had higher rates of nutritional deficiency anemia (14.20% vs. 9.67%; p = 0.04) but lower rates of diabetes (23.30% vs. 39.57%; p &lt; 0.001), hyperlipidemia (26.70% vs. 40.85%; p &lt; 0.001), chronic heart failure (6.25% vs. 11.07%; p = 0.04), coronary artery disease (26.70% vs. 43.13%; p &lt; 0.001), and chronic kidney disease (27.27% vs. 36.17%; p = 0.02). The IBD group also had a lower incidence of acute myocardial infarction (2.84% vs. 12.95%; p &lt; 0.001). There was no significant difference in mortality, mean length of stay LOS, and THC. After adjusting for potential confounders, HIT patients with IBD had lower odds of acute myocardial infarction (MI) (adjusted odds ratio (aOR) 0.26; p = 0.004) and acute venous thromboembolism (VTE) (aOR 0.63; p = 0.04).

Conclusion: Our study found that patients with HIT and IBD had lower odds of experiencing acute MI and VTE. This can be attributed to the systemic anti-inflammatory effects of the medications commonly used to treat IBD patients, which help reduce inflammation and, consequently, the risk of thrombotic events. However, our study is limited by the constraints of the NIS database, such as the inability to account for disease severity, home medications, and specific treatment regimens. Further research is needed to fully understand the underlying mechanisms.