Abstract
Introduction: In patients with cirrhosis, systemic inflammation disrupts hemostatic balance similarly to inflammatory bowel disease (IBD), potentially leading to a procoagulant or anticoagulant state. Despite guidelines supporting anticoagulation use in hospitalized IBD patients, evidence is weak, and there are no specific guidelines for those with cirrhosis. This study aims to explore how cirrhosis affects coagulopathy and gastrointestinal bleeding in IBD patients to inform decisions on anticoagulation therapy. Patients and Methods: Using the National Inpatient Sample database, hospitalizations with IBD and cirrhosis diagnoses from 2016 to 2020 were identified. Pregnant women, patients on chronic anticoagulation, and those with malignancies were excluded. 1:1 matching for comorbidities was performed. Primary outcome: upper GI bleed; secondary outcomes: mortality, venous thromboembolism (VTE), length of stay. Results: Among IBD patients, 5,375 had cirrhosis. After matching, both groups comprised 4,195 patients. In matched cohorts, IBD patients with cirrhosis had increased risk of upper GI bleeding (RR-3.60, p < 0.0001) and mortality (RR-2.78, p < 0.002), with no significant difference in VTE events (RR-1.70, p-0.446). Length of stay did not differ significantly. Conclusion: This study reveals a higher incidence of upper GI bleeding in IBD patients with cirrhosis, emphasizing the need for close monitoring. The efficacy of anticoagulation in preventing thromboembolic events in these patients remains uncertain due to increased bleeding risk. Further randomized trials are needed to evaluate anticoagulation effects considering varying cirrhosis severity.