The relationship between coagulation state and inflammatory bowel disease: current understanding and clinical implications

Abstract

Inflammatory bowel disease (IBD) is associated with a hypercoagulable state and subsequently with an increased risk for venous thromboembolism (VTE). VTE in IBD is characterized by a high recurrence rate and is associated with the disease activity. Acquired endothelial dysfunction, abnormalities of platelets, activation of coagulation system and impaired fibrinolysis are the main changes in the coagulation state in IBD. The development of VTE in IBD has been considered to be the result of multiple interactions between acquired and inherited risk factors. The treatment of VTE in IBD patients is recommended to be similar and to follow the same protocols as for non-IBD patients. In the clinical practice, the management of IBD patients and especially the hospitalized patients should include thromboprophylaxis.

Keywords:

• angiogenesis
• Crohn’s disease
• factor V Leiden
• homocysteine
• ulcerative colitis
• venous thromboembolism

Financial & competing interests disclosure

The author has no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Key issues

• Inflammatory bowel disease (IBD) patients present a two- to threefold higher risk of development of venous thromboembolism (VTE) compared with healthy controls.

• The main changes in the coagulation state in IBD are acquired endothelial dysfunction, abnormalities of platelets, activation of coagulation system and impaired fibrinolysis.

• The recurrence rate of VTE in IBD patients is increased and mainly associated with disease activity.

• The mortality rate in IBD patients with VTE is 2.5-fold higher compared with IBD patients without VTE.

• Risk factors for development VTE specific for IBD are the disease activity, disease localization, disease phenotype, IBD-related medications and bowel surgery.

• Genetic risk factors which are established as important for development of VTE are rather uncommon in patients with IBD but when present increase the risk of VTE.

• The treatment of VTE in IBD patients is similar and should follow the same protocols as for non-IBD patients.

• The management of IBD patients and especially the hospitalized and the high-risk patients should include thromboprophylaxis.

Notes