Abstract
Inflammatory bowel disease (IBD) is associated with an increased risk of vascular complications. The most important of these complications are arterial and venous thromboembolism, which represent a significant cause of morbidity and mortality in IBD patients. Recent data suggest that thromboembolism is a disease-specific extraintestinal manifestation of IBD. The most common thrombotic manifestations in IBD are deep vein thrombosis of the leg and pulmonary emboli. It has been suggested that disease activity and the extent of colonic localization are correlated with the risk of developing thromboembolism. The occurrence of thrombosis in patients with IBD is partially attributed to the existing hypercoagulable state in IBD. Both coagulation and fibrinolysis are activated in patients with IBD; this is especially true for those with active disease. The most common risk factors for thrombophilia in IBD patients with venous thromboembolism are Leiden mutation in the gene encoding factor V, hyperhomocysteinemia, and antiphospholipid antibodies. The main genetic defects that have been established as risk factors for venous thrombosis are rather uncommon in IBD, but when present increase the risk of thromboembolism. Screening for coagulation defects seems justified only in IBD patients with a history of thrombosis or a family history of venous thromboembolic events. Antithrombotic treatment of IBD patients with venous thromboembolism is similar to that of thrombotic non-IBD patients.
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References
Talbot RW et al. (1986) Vascular complications of inflammatory bowel disease. Mayo Clin Proc 61: 140–145
Solem CA et al. (2004) Venous thromboembolism in inflammatory bowel disease. Am J Gastroenterol 99: 97–101
Hatoum OA and Binion DG (2005) The vasculature and inflammatory bowel disease: contribution to pathogenesis and clinical pathology. Inflam Bowel Dis 11: 304–313
Danese S et al. (2003) Activated platelets are the source of elevated levels of soluble CD40 ligand in the circulation of inflammatory bowel disease patients. Gut 52: 1435–1441
Levy PJ et al. (1997) Lower extremity arterial occlusions in young patients with Crohn's colitis and premature atherosclerosis: report of six cases. Am J Gastroenterol 92: 494–497
Nuutinen H et al. (1995) Association of ulcerative colitis and ischemic heart disease [abstract]. Gastroenterology 108: a886
Nuutinen H et al. (1996) Association of Crohn's disease and ischemic heart disease [abstract]. Gastroenterology 110: a981
Ruby AJ and Jampol LM (1990) Crohn's disease and retinal vascular disease. Am J Ophthalmol 110: 349–353
Sato R et al. (1994) Takayasu's disease associated with ulcerative colitis. Intern Med 33: 759–763
Bargen JA and Barker NW (1936) Extensive arterial and venous thrombosis complicating chronic ulcerative colitis. Arch Intern Med 58: 17–31
Koutroubakis IE (2001) Unraveling the mechanisms of thrombosis in inflammatory bowel disease. Am J Gastroenterol 96: 1325–1327
Koutroubakis IE (2000) Role of thrombotic risk factors in inflammatory bowel disease. Dig Dis 18: 161–167
Graef V et al. (1965) Venous thrombosis occuring in non-specific ulcerative colitis. Arch Intern Med 117: 377–382
Miehsler W et al. (2004) Is inflammatory bowel disease an independent and disease-specific risk factor for thromboembolism? Gut 53: 542–548
Bernstein CN et al. (2001) The incidence of deep venous thrombosis and pulmonary embolism among patients with inflammatory bowel disease: a population–based cohort study. Thromb Haemost 85: 430–434
Grip O et al. (2000) Inflammatory bowel disease promotes venous thrombosis earlier in life Scand J Gastroenterol 35: 619–623
Esmon CT (2003) Inflammation and thrombosis. J Thromb Haemost 1: 1343–1348
Stadnicki A et al. (1997) Activation of plasma contact and coagulation systems and neutrophils in the active phase of ulcerative colitis. Dig Dis Sci 42: 2356–2366
van Bodegraven AA et al. (2002) Persistent activation of coagulation and fibrinolysis after treatment of active ulcerative colitis. Eur J Gastroenterol Hepatol 14: 413–418
van Bodegraven AA (2003) Haemostasis in inflammatory bowel diseases: clinical relevance. Scand J Gastroenterol 239 (Suppl): S51–S62
Saibeni S et al. (2004) Assessment of thrombin-activatable fibrinolysis inhibitor (TAFI) plasma levels in inflammatory bowel diseases. Am J Gastroenterol 99: 1966–1970
Danese S et al. (2004) Platelets in inflammatory bowel disease: clinical, pathogenic, and therapeutic implications. Am J Gastroenterol 99: 938–945
Koutroubakis IE et al. (2004) Association between enhanced soluble CD40 ligand and prothrombotic state in inflammatory bowel disease. Eur J Gastroenterol Hepatol 16: 1147–1152
Wakefield AJ et al. (1989) Pathogenesis of Crohn's disease: multifocal gastrointestinal infarction. Lancet 2: 1057–1062
Wakefield AJ et al. (1991) Granulomatous vasculitis in Crohn's disease. Gastroenterology 100: 1279–1287
Thompson NP et al. (1995) Inherited disorders of coagulation appear to protect against inflammatory bowel disease. Gastroenterology 108: 1011–1015
Gaffney PR et al. (1995) Paradoxical response to heparin in 10 patients with ulcerative colitis. Am J Gastroenterol 90: 220–223
Torkvist L et al. (1999) Low molecular weight heparin as adjuvant therapy in active ulcerative colitis. Aliment Pharmacol Ther 13: 1323–1328
Weijl NI et al. (2000) Thromboembolic events during chemotherapy for germ cell cancer: a cohort study and review of the literature. J Clin Oncol 18: 2169–2178
Mijnhout GS et al. (2004) Sepsis and elevated liver enzymes in a patient with inflammatory bowel disease: think of portal vein thrombosis. Dig Liver Dis 36: 296–300
Junge U et al. (2001) Acute Budd-Chiari syndrome, portal and splenic vein thrombosis in a patient with ulcerative colitis associated with antiphospholipid antibodies and protein C deficiency. Z Gastroenterol 39: 845–852
Fichera A et al. (2003) Superior mesenteric vein thrombosis after colectomy for inflammatory bowel disease: a not uncommon cause of postoperative acute abdominal pain. Dis Colon Rectum 46: 643–648
Novotny DA et al. (1992) Arterial thromboembolic complications of inflammatory bowel disease. Report of three cases. Dis Colon Rectum 35: 193–196
Szychta P et al. (2001) Aortic thrombosis and ulcerative colitis. Ann Vasc Surg 15: 402–404
Ashkan K et al. (1998) Arterial thrombosis: a complication of loop ileostomy. Eur J Gastroenterol Hepatol 10: 795–796
Novacek G et al. (2004) Aortic mural thrombi in patients with inflammatory bowel disease: report of two cases and review of the literature. Inflamm Bowel Dis 10: 430–435
Efremidis M et al. (1999) Acute myocardial infarction in a young patient during an exacerbation of ulcerative colitis. Int J Cardiol 70: 211–212
Papa A et al. (2003) Review article: inherited thrombophilia in inflammatory bowel disease. Am J Gastroenterol 98: 1247–1251
Vecchi M et al. (2000) Inflammatory bowel diseases are not associated with major hereditary conditions predisposing to thrombosis. Dig Dis Sci 45: 1465–1469
Guédon C et al. (2001) Prothrombotic inherited abnormalities other than factor V Leiden mutation do not play a role in venous thrombosis in inflammatory bowel disease. Am J Gastroenterol 96: 1448–1454
Koutroubakis IE et al. (1998) Anti-cardiolipin and anti-beta2-glycoprotein I antibodies in patients with inflammatory bowel disease. Dig Dis Sci 43: 2507–2512
Aichbichler BW et al. (1999) Anti-cardiolipin antibodies in patients with inflammatory bowel disease. Dig Dis Sci 44: 852–856
Oldenburg B et al. (2005) Risk factors for thromboembolic complications in inflammatory bowel disease: the role of hyperhomocysteinaemia. Dig Dis Sci 50: 235–240
Koutroubakis IE et al. (2001) Increased levels of Lipoprotein (a) in Crohn's disease: a relation to thrombosis? Eur J Gastroenterol Hepatol 13: 1415–1419
Koutroubakis IE et al. (2000) Resistance to activated protein C and low levels of free protein S in Greek patients with inflammatory bowel disease. Am J Gastroenterol 95: 190–194
Liebman HA et al. (1998) The factor V Leiden mutation increases the risk of venous thrombosis in patients with inflammatory bowel disease. Gastroenterology 115: 830–834
Papa A et al. (2000) Prevalence of factor V Leiden and the G20210A prothrombin-gene mutation in inflammatory bowel disease. Blood Coagul Fibrinolysis 11: 499–503
Cattaneo M et al. (1998) High prevalence of hyperchomocysteinemia in patients with inflammatory bowel disease: a pathogenic link with thromboembolic complications? Thromb Haemost 80: 542–545
Koutroubakis IE et al. (2000) Hyperhomocysteinemia in Greek patients with inflammatory bowel disease. Dig Dis Sci 45: 2347–2351
Morgenstern I et al. (2003) Homocysteine, cysteine, and glutathione in human colonic mucosa: elevated levels of homocysteine in patients with inflammatory bowel disease. Dig Dis Sci 48: 2083–2090
Mahmud N et al. (1999) Increased prevalence of methylenetetrahydrofolate reductase C677T variant in patients with inflammatory bowel disease, and its clinical implications. Gut 45: 389–394
Danese S et al. (2005) Homocysteine triggers mucosal microvascular activation in inflammatory bowel disease. Am J Gastroenterol 100: 886–895
Turpie AG et al. (2002) ABC of antithrombotic therapy: Venous thromboembolism: treatment strategies. BMJ 325: 948–950
Kao A et al. (2002) Anticoagulation therapy in cerebral sinovenous thrombosis and ulcerative colitis in children. J Child Neurol 17: 479–482
Lengle SJ et al. (1995) Arterial thrombosis in ulcerative colitis: transcatheter thrombolytic therapy. West J Med 162: 543–547
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Glossary
- HYPERHOMOCYSTEINEMIA
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Elevation of the plasma homocysteine concentration—a common and important risk factor for atherosclerotic arterial disease and for venous thromboembolism
- EUGLOBULIN LYSIS TIME
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A measure of the activity of the fibrinolytic (clot-breakdown) system; it is one of the best tests to differentiate primary fibrinolysis from disseminated intravascular coagulation
- INFERIOR VENA CAVA (IVC) FILTERS
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Devices to block passage of venous emboli from the lower extremities or pelvis through the IVC into the pulmonary arteries
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Koutroubakis, I. Therapy Insight: vascular complications in patients with inflammatory bowel disease. Nat Rev Gastroenterol Hepatol 2, 266–272 (2005). https://doi.org/10.1038/ncpgasthep0190
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DOI: https://doi.org/10.1038/ncpgasthep0190
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