The frequency of thrombosis in inflammatory bowel disease and the effect of thrombosis on the course of the disease

Abstract

Backgrounds and Aims: Inflammatory bowel disease increases the risk of thrombosis. Here we have present our patients with ulcerative colitis and Crohn’s disease having thrombosis, their clinical course, and the properties of thrombosis in these patients. Materials and Methods: A total of 3.128 patients who were followed up in the Türkiye Yüksek İhtisas Training and Research Hospital Inflammatory Bowel Disease Department were investigated for thrombosis. Results: Of the total, 20 patients with thrombosis were included in the study. The median age of the patients was 40,45 (22-70 years). Of these, 16 patients were men and 6 were women. Thrombosis was diagnosed in deep veins in 10 patients. In addition, 4 patients were diagnosed with pulmonary emboly with deep vein thrombosis, 3 thrombophlebitis, 1 with cerebral vein thrombosis, 1 with mesenteric vein thrombosis, and 2 with portal and hepatic vein thrombosis. The median time between the first inflammatory bowel disease diagnosis and the thrombosis diagnosis was 16 months (2-240). Thrombosis was diagnosed in 15 patients while they were in the active phase of their disease. The treatment of 13 patients was upgraded during their clinical course. Conclusion: Inflammatory bowel disease is a thrombophilic condition. An early diagnosis and appropriate treatment of these patients are essential in order to reduce morbidity and mortality. Thrombosis may predict severe disease. An active disease must be considered as a pre-thrombotic situation, and prophylactic anticoagulation must be integrated within the treatment.

Keywords

• Inflammatory bowel disease,ulcerative colitis,Crohn’s disease,thrombosis

İnflamatuvar barsak hastalıklarında tromboz sıklığı ve trombozun hastalık seyrine olan etkisi

Öz

Giriş ve Amaç: Normal popülasyona göre inflamatuvar barsak hastalığının tromboz riskinde artışla beraber olduğu iyi bilinir. Biz burada ülseratif kolit ve Crohn hastalığı olan hastalarımızda tromboz sıklığını, tromboz saptanan hastaların klinik seyirlerini ve trombozların özelliklerini belirlemeyi amaçladık. Gereç ve Yöntem: Türkiye Yüksek İhtisas Eğitim ve Araştırma Hastanesi İnflamatuvar Barsak Hastalıkları polikliniğinde takip edilen 3128 hasta tromboz yönünden retrospektif olarak incelendi. Bulgular: Çalışmamıza toplam 20 hasta alındı. Hastaların yaş ortalaması 40,45 (22-70) olup 16 hasta erkek, 4 hasta kadındı. Hastalarımızın 10 tanesinde tromboz bacak derin venlerinde iken 4 hastada bacak derin venleriyle beraber pulmoner emboli şeklinde görüldü. 2 hastada tromboflebit, 1 hastada serebral ven trombozu, 1 hastada mezenterik ven trombozu ve 2 hastada da portal ve hepatik ven trombozu olarak görüldü. İlk inflamatuvar barsak hastalığı tanısı ile ilk tromboz tanısı arası geçen süre ortanca 16 ay (2-240)’dı. Trombozlar 15 hastada aktif hastalık esnasında oluşmuştu. 20 hastanın 13 tanesinde tromboz tanısı sonrası aldıkları medikal tedavilerde bir üst basamağa geçiş görüldü. Sonuç: İnflamatuvar barsak hastalığı tromboza zemin hazırlayan bir hastalıktır. Tromboz gelişen hastaların erken tanı ve tedavisi morbidite ve hatta mortalitede azalmaya neden olacaktır. Tromboz ciddi seyredecek inflamatuvar barsak hastalığının habercisi olabilir. Aktif hastalık özellikle pretomboti bir durum olarak değerlendirilmeli ve gerekli antikoagülasyon başlanmalıdır.

Anahtar Kelimeler

• İnflamatuvar barsak hastalığı,ülseratif kolit ve Crohn hastalığı,tromboz

Kaynakça

1. 1. Colìa R, Corrado A, Cantatore FP. Rheumatologic and extraintestinal manifstations of inflammatory bowel disease. Ann Med 2016;16:1-9.
2. 2. Talbot RW, Heppell J, Dozois RR, et al. Vascular complications of inflammatory bowel disease. Mayo Clin Proc 1986;61:140-5.
3. 3. Graef V, Baggenstoss AH, Sauer WG, et al. Venous thrombosis in non-specific ulcerative colitis. A necropsy study. Arch Intern Med 1965;117:377-82.
4. 4. Owczarek D, Cibor D, Głowacki MK, et al. Inflammatory bowel disease: epidemiology, pathology and risk factors for hypercoagulability. World J Gastroenterol 2014;20:53-63.
5. 5. Fumery M, Xiaocang C, Dauchet L, et al. Thromboembolic events and cardiovascular mortality in inflammatory bowel diseases: a meta-analysis of observational studies. J Crohns Colitis 2014;8:469-79.
6. 6. Danese S, Papa A, Saibeni S, et al. Inflammation and coagulation in inflammatory bowel disease: The clot thickens. Am J Gastroenterol 2007;102:174-86.
7. 7. Tsiolakidou G, Koutroubakis IE. Thrombosis and inflammatory bowel disease-the role of genetic risk factors. World J Gastroenterol 2008;14:4440-4.
8. 8. Koutroubakis IE, Sfiridaki A, Mouzas IA, et al. Resistance to activated protein C and low levels of free protein S in Greek patients with inflammatory bowel disease. Am J Gastroenterol 2000;95:190-4.

9. 9. Spina L, Saibeni S, Battaglioli T, et al. Thrombosis in inflammatory bowel diseases: role of inherited thrombophilia. Am J Gastroenterol 2005;100:2036-41.
10. 10. Oldenburg B, Van Tuyl BA, van der Griend R, et al. Risk factors for thromboembolic complications in inflammatory bowel disease: the role of hyperhomocysteinaemia. Dig Dis Sci 2005;50:235-40
11. 11. Roifman I, Sun YC, Fedwick JP, et al. Evidence of endothelial dysfunction in patients with inflammatory bowel disease. Clin Gastroenterol Hepatol 2009;7:175-82.
12. 12. Merrill A, Millham F. Increased risk of postoperative deep vein thrombosis and pulmonary embolism in patients with inflammatory bowel disease: a study of National Surgical Quality Improvement Program patients. Arch Surg 2012;147:120-4.
13. 13. Landman C, Nahon S, Cosnes J, et al. Portomesenteric vein thrombosis in patients with inflammatory bowel disease. Inflamm Bowel Dis 2013;19:582-9.
14. 14. Yuhara H, Steinmaus C, Corley D, et al. Meta-analysis: the risk of venous thromboembolism in patients with inflammatory bowel disease. Aliment Pharmacol Ther 2013;37:953-62.
15. 15. Mantaka AN, Samonakis DN, Liontiris M, et al. Ulcerative colitis and Budd-Chiari syndrome: which comes first? Eur J Gastroenterol Hepatol 2014;26:1306.
16. 16. Abdul-Rahman AM, Raj R. Bilateral retinal branch vascular occlusion-a first presentation of crohn disease. Retin Cases Brief Rep 2010;4:102-4.
17. 17. Szychta P, Reix T, Sevestre MA, et al. Aortic thrombosis and ulcerative colitis. Ann Vasc Surg 2001;15:402-4.
18. 18. Novacek G, Haumer M, Schima W, et al. Aortic mural thrombi in patients with inflammatory bowel disease: report of two cases and review of the literature. Inflamm Bowel Dis 2004;10:430-5.
19. 19. Geerts WH, Bergqvist D, Pineo GF, et al. Prevention of venous thromboembolism: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest 2008;133:381S-453S.
20. 20. Nguyen GC, Bernstein CN. Duration of anticoagulation for the management of venous thromboembolism in inflammatory bowel disease: a decision analysis. Am J Gastroenterol 2013;108:1486-95.