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Recurrent deep vein thrombosis despite warfarin therapy in a patient with Crohn's disease

Pablo R Lopez1, David W Stewart, Roger D Smalligan

  • 1Department of Internal Medicine, James H. Quillen College of Medicine, East Tennessee State University, Johnson City, TN, USA. pablolopezmd@gmail.com

Postgraduate Medicine
|May 14, 2010
PubMed

Insights

Patients with inflammatory bowel disease (IBD) face a higher risk of blood clots. Even on warfarin, a Crohn's patient experienced a new deep vein thrombosis, highlighting the need for vigilance in managing IBD-related thromboembolic events.

Area of Science:

  • Gastroenterology and Hematology
  • Clinical Case Study

Background:

  • Patients with inflammatory bowel disease (IBD) exhibit an elevated risk of thromboembolic events.
  • Long-term warfarin therapy is often effective for managing recurrent thromboembolic events in high-risk IBD patients.

Observation:

  • A 66-year-old woman with Crohn's disease developed a new deep vein thrombosis.
  • Despite meticulous international normalized ratio (INR) management, anticoagulation with warfarin was insufficient to prevent recurrence.

Findings:

  • The patient required an inferior vena cava filter in addition to warfarin to prevent recurrent pulmonary emboli.
  • This case underscores the complex interplay between IBD, anticoagulation, and thrombosis.

Implications:

  • Physicians should maintain a low threshold for diagnosing thromboembolic events in IBD patients, even those on anticoagulation.
  • Understanding contributing factors to hypercoagulability in IBD is crucial for optimizing patient care and preventing thrombotic events.

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