Real world data analysis of venous thromboembolism, adverse major cardiovascular events, neoplasia and serious infections in ulcerative colitis patients

Venous thromboembolism (VTE), major adverse cardiovascular events (MACE), neoplasia, and serious infections are significant complications associated with Immune-mediated inflammatory diseases. Actually, the occurrence of such complications in these patients has been observed to be higher than that anticipated from classical risk factors alone. Additionally, the administration of anti-inflammatory treatments, such as corticosteroids, associated to inflammatory diseases is recognized to further elevate this risk. In Spain, data on the prevalence of risk of cardiovascular events, neoplasia or serious infections, particularly among individuals with ulcerative colitis are scarce. This study leverages real-world data from the Andalusian Health Population Database (BPS) to analyze the incidence and risk factors of these complications among ulcerative colitis patients. A cohort of 23,518 patients, aged 18 years or older, with an ulcerative colitis diagnosis between 2010 and 2019, was used in the study. The objective was to assess the incidence of VTE, MACE, neoplasms, and serious infections and to evaluate the impact of age and other factors related to ulcerative colitis on these outcomes.

The study revealed a notably higher incidence of VTE and MACE in ulcerative colitis patients compared to the incidence described for the general population, particularly among those over 60 years of age. Specifically, the incidence of VTE was significantly elevated post-diagnosis, with deep vein thrombosis (DVT) and pulmonary embolism, being the most common manifestations. MACE, including myocardial infarction and stroke, also presented a higher risk, especially in older patients. Also, a significant portion of patients developed various malignancies. Also remarkable is the significant higher incidence of VTE, malignancies and serious infections as the severity of ulcerative colitis increases. The use of immunosuppressive therapies was associated with an increased risk of infections, and likely with VTE and malignancies, further complicating the management of these patients.

The findings of this study underscore the need for heightened vigilance in the management of ulcerative colitis patients, particularly those at advanced ages. Preventive strategies, such as thromboprophylaxis during hospitalization and regular monitoring for cardiovascular and neoplastic complications, are essential. The study contributes valuable insights into the burden of comorbidities in ulcerative colitis and highlights the importance of tailored treatment and monitoring strategies to improve patient outcomes.