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Endoscopic activity, tissue factor and Crohn's disease: findings in clinical remission patients

Adriana Ribas Andrade1, Tania Rubia Flores da Rocha1, Carmen Lucia Ortiz-Agostinho1

  • 1Gastroenterology, Laboratório de Gastroenterologia Clínica e Experimental (LIM 07), University of Sao Paulo School of Medicine, Sao Paulo, Brazil.

Therapeutic Advances in Gastroenterology
|May 24, 2021
PubMed

Insights

Crohn's disease patients with endoscopic activity show higher tissue factor levels, indicating coagulation activation. Further research is needed to validate thromboprophylaxis for these patients.

Area of Science:

  • Gastroenterology
  • Hematology
  • Immunology

Background:

  • Crohn's disease (CD) is linked to increased risk of thromboembolic events (TE).
  • Subclinical inflammation in CD patients may contribute to TE risk.
  • Endoscopic activity (EA) in clinically remissed CD patients warrants investigation for its impact on coagulation.

Purpose of the Study:

  • To evaluate the correlation between endoscopic activity (EA) and coagulation profiles in Crohn's disease (CD) patients.
  • To assess if EA in clinically remissed CD patients influences markers of coagulation activation.
  • To identify potential prothrombotic states in CD patients with varying degrees of endoscopic inflammation.

Main Methods:

  • 164 consecutive CD patients in clinical remission (CDAI < 150) were divided into EA (SES-CD ≥ 7) and endoscopic remission (ER) (SES-CD ≤ 2) groups.
  • 75 patients were in the EA group, 89 in the ER group, and 50 healthy individuals served as controls.
  • Coagulation markers including tissue factor (TF), factor VIII (FVIII), thrombomodulin (TM), ADAMTS-13, von Willebrand factor (VWF), and endogenous thrombin potential (ETP) were analyzed.

Main Results:

  • Mean plasma TF activity was significantly higher in the EA group (127 pM) compared to ER (103 pM) and controls (84 pM).
  • VWF:Ag, VWF/ADAMTS-13, FVIII, and TM levels were elevated in CD patients (both EA and ER groups) compared to controls, but not significantly different between EA and ER groups.
  • Endogenous thrombin potential (ETP) remained consistent across all three groups.

Conclusions:

  • Endoscopic activity in clinically remissed CD patients is associated with endothelial lesions and increased tissue factor exposure.
  • This leads to activation of the coagulation cascade in CD patients with EA.
  • Further investigation is recommended to validate thromboprophylaxis strategies for CD patients with endoscopic activity.
Abstract

Keywords:
Crohn’s diseaseendoscopic activitythrombosistissue factor

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