No Increased Risk of Venous Thromboembolism or Infectious Complications after Janus Kinase Inhibitor Exposure in Patients with Ulcerative Colitis Undergoing Surgery.

Introduction: Total colectomy for ulcerative colitis (UC) is associated with postoperative morbidity, including venous thromboembolic events (VTE). In light of recent concerns about increased major adverse events associated with Janus kinase (JAK) inhibitor exposure, we aimed to evaluate the postoperative VTE risk as well as other complications in UC patients undergoing colectomy.

Methods: This single-center retrospective cohort study included all UC patients who underwent (procto)colectomy between 2013 and March 2022 and documented the 180-day postoperative non-infectious and infectious complications.

Results: One hundred seventy-five UC patients (43.4% women, median age 41.0 years) underwent colectomy. Forty-nine patients (28.0%) were operated in an urgent setting. In the 12 weeks prior to surgery, 53 (30.3%) patients had received anti-TNF agents, 40 (22.9%) anti-adhesion therapy, 16 (9.1%) anti-IL12/23, and 34 (19.4%) JAK inhibitors. Preoperatively, 26 patients (14.9%) received moderate-to-high doses of systemic corticosteroids. All except 2 patients received prophylactic low-molecular-weight heparin postoperatively. During the 180-day postoperative period, 2 patients developed thrombosis, all incidental findings on abdominal CT scan. No VTE was seen in the patients who underwent colectomy while on JAK inhibitor. Three out of 34 JAK inhibitor-treated patients (8.8%) developed a postoperative infectious complication, while the overall incidence of infectious complications was 17.1%.

Conclusion: Our findings suggest that the overall VTE risk in UC patients undergoing colectomy is low with adequate antithrombotic prophylaxis. JAK inhibitor use prior to surgery was not linked to increased short-term thromboembolic or infectious complications. However, the limited sample size warrants further study in larger cohorts.