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Background: Venous thromboembolism (VTE) is a well-recognised extra-intestinal manifestation of inflammatory bowel disease (IBD). Despite the widespread support for anticoagulant prophylaxis in hospitalised IBD patients, the utilisation and efficacy in clinical practice are unknown. Aim(s): The aim of this study was to assess the prevalence and clinical features of VTE among hospitalised IBD patients and ascertain whether appropriate thromboprophylaxis had been administered. Method(s): All patients with a discharge diagnosis of Crohn disease or ulcerative colitis and VTE were retrospectively identified using International Classification of Diseases, tenth revision codes from medical records at our institution from July 1998 to December 2009. Medical records were then reviewed for clinical history and utilisation of thromboprophylaxis. Statistical analysis was performed by Mann-Whitney test and either chi2 tests or Fisher's exact tests. Result(s): Twenty-nine of 3758 (0.8%) IBD admissions suffered VTE, 13 preadmission and 16 during admission. Of these 29 admissions (in 25 patients), 24% required intensive care unit and 10% died. Of the 16 venous thrombotic events that occurred during an admission, eight (50%) did not receive anticoagulant thromboprophylaxis and eight (50%) occurred despite thromboprophylaxis. Most thromboembolism despite prophylaxis occurred post-intestinal resection (n = 5, 63%). Conclusion(s): Thromboprophylaxis is underutilised in half of IBD patients suffering VTE. Prescription of thromboprophylaxis for all hospitalised IBD patients, including dual pharmacological and mechanical prophylaxis in postoperative patients, may lead to a reduction in this preventable complication of IBD. © 2014 Royal Australasian College of Physicians.

Background Inflammatory bowel disease (IBD) is associated with an increased risk of thromboembolism (TE). Hospitalised patients with IBD have a higher morbidity and mortality associated with TE. Many IBD patients do not receive adequate thromboprophylaxis, despite the existence of hospital protocols. Aims The aim of this study was to assess whether education and reinforcement of hospital thromboprophylaxis protocols was effective in increasing the rates of thromboprophylaxis given to hospitalised IBD patients. Methods All patients with a diagnosis of IBD, coded according to the ICD tenth revision, were identified from a coding search of separations from Southern Health (Monash Medical Centre and Dandenong Hospital). An initial audit for patients admitted between December 2009 to May 2010, assessed rates of thromboprophylaxis. This was followed by reinforcement of pre-existing hospital thromboprophylaxis protocols via an email with the protocol and direct verbal education from the IBD physician to the registrars, highlighting the importance of thromboprophylaxis in IBD patients. Post-reinforcement, a further audit of all IBD admission from July 2010 to January 2011 assessed compliance with the thromboprophylaxis guidelines. Analysis of rates was performed using a two tailed Fisher's exact test. Results There were 36 multi-day admissions for IBD prior to the intervention and 91 in the 6 months post intervention. Thirty out of 36 (83.3%) pre-intervention and 69 out of 91 (75.8%) post-intervention patients received appropriate thromboprophylaxis, a difference that was not statistically significant (p = 0.517). In the 30 pre-intervention patients who received thromboprophylaxis, 26 (86.7%) received 40 mg enoxaparin s/c daily and 4 received alternative thromboprophylaxis (heparin 5000 units s/c BD, 100 mg or 20 mg subcutaneous enoxaparin). 58 patients out of 91 receiving thromboprophylaixs post-intervention (63.7%) received 40 mg enoxaparin, with no statistical difference

Thromboembolism (TE) is a significant cause of morbidity and mortality in patients with Inflammatory Bowel Disease (IBD). Despite therapeutic guidelines and hospital protocols, many IBD patients do not receive thromboprophylaxis. Method(s): All patients with a diagnosis of Crohn's disease (CD) or ulcerative colitis (UC) and a diagnosis of venous or arterial TE were retrospectively identified from medical record coding at our institution from July 1998 to December 2009. Clinical history, risk factors, treatment and outcomes were obtained. A further audit of all IBD admissions from December 2009 to May 2010 assessed compliance with thromboprophylaxis guidelines. Result(s): 47 patients with a diagnosis of IBD developed 58 TE events, of which 23 (39.7%) had UC and 35 (60.3%) had CD. Mean age was 57 years (range 20-90), 48% were female, and 88.9% of patients were on IBD therapy. Venous TE occurred in 29 (50%) patients, 18 (31%) with a pulmonary embolus. There were 12 (20.7%) acute coronary syndromes, 12 (20.7%) strokes and 5 (8.6%) other arterial thromboses, and 19% of events occurred post-operatively. During the index admission 15.5% of patients died and 15.5% required intensive care. Clinical associations included previous TE (32.8%), hypertension (30.0%), current smoking (24.1%), and previous IBD surgery (24.1%). CRP was elevated in 82.9%, leukocytosis in 32.7% and thrombocytosis in 23.6% of patients. Twenty-three (39.7%) patients presented with TE and of the 35 (60.3%) patients developing TE during the admission, 16 (45%) were on thromboprophylaxis and 19 (54.3%) were not. Analysis by admission date (prior vs since 1st May 2004) revealed fewer inpatient TE events in patients not receiving thromboprophylaxis (61.5% vs 40% (p < 0.05)). Of the last 36 multiday admissions with IBD diagnoses, 30 (83.3%) received appropriate thromboprophylaxis, and of the remaining 6 patients (16.7%), no contraindications to thromboprophylaxis were identified. Conclusion(s): There was a hi

The principal findings are presented from a study of mining wastes in California which considered the magnitude of the waste problem, the best feasible control measures for waste management and disposal, abatement and clean-up at problem sites, and current regulations imposed on mining waste disposal., The principal findings are presented from a study of mining wastes in California which considered the magnitude of the waste problem, the best feasible control measures for waste management and disposal, abatement and clean-up at problem sites, and current regulations imposed on mining waste disposal.