Résumé
Patients with chronic inflammatory bowel disease (IBD) are at higher risk of venous thromboembolism (VTE) compared with general population. VTE prophylaxis relies on subcutaneous low-molecular-weight heparin. However, direct oral anticoagulants may be a more acceptable alternative with similar risk-benefit ratio. Objective: to compare acceptability of direct oral anticoagulant versus subcutaneous lowmolecular weight heparin in patients with IBD. Materials and methods: data were collected prospectively via a questionnaire submitted to all IBD patients with an indication for VTE prophylaxis in 6 French hospitals from September 2023 to June 2024. Questionnaire included numerical scales (NS) of acceptability of anticoagulant treatments from 0 (worst acceptability) to 10 (better acceptability). Results: 91 patients were included (46 with Crohn's disease, median age 38 and median IBD duration 9 years). Three patients had already had a venous thromboembolic event, 12% had other VTE risk factors, and 44% of patients had already been treated with subcutaneous enoxaparin prior to inclusion. Enoxaparin was prescribed for two weeks in 48% of cases. Means of numerical acceptability scales showed higher acceptability of daily oral treatment (8.7 for once-daily and 8.3 for twice-daily treatments) compared to daily subcutaneous treatment (7.2 for once-daily and 5.4 for twice-daily) (p<0.001 for all comparisons with oral route). Acceptability was ≥7 for 84% and 82% of patients for the oral form (once and twice daily respectively) and ≤4 for 21% and 40% of patients for the subcutaneous form (once and twice daily). Main contributors of the choice of oral route were pain after subcutaneous injection, assuming responsibility of injection and need for nurse for injections. Conclusion: acceptability of anticoagulant treatment was higher using oral route compared to subcutaneous route, regardless of treatment frequency. Using oral anticoagulant may be associated with higher treatment adherence and lower risk of VTE in the IBD population.