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Determination of prothrombin activation fragments in young patients with inflammatory bowel disease
C J Smith1, W D Haire, S S Kaufman
1Department of Pediatrics, University of Nebraska Medical Center, Omaha 68198-5160, USA.
Insights
Coagulation cascade activation, indicated by elevated prothrombin fragment 1.2 (F1.2), is linked to thromboembolic risk in active inflammatory bowel disease (IBD). This risk persists even after disease remission, suggesting vigilance is needed.
Area of Science:
- Gastroenterology and Hematology
- Thrombosis and Hemostasis Research
Background:
- Inflammatory bowel disease (IBD) is associated with an increased risk of thromboembolic events.
- The precise mechanisms underlying this heightened risk are not fully understood.
- Assessing coagulation activation may provide insights into thromboembolic risk in IBD patients.
Purpose of the Study:
- To evaluate the activation of the coagulation cascade as a potential biomarker for thromboembolic risk in patients with IBD.
- To correlate levels of prothrombin fragment 1.2 (F1.2) with disease activity in Crohn's disease (CD) and ulcerative colitis (UC).
Main Methods:
- Fifty plasma samples were collected from 29 IBD patients (23 CD, 6 UC) categorized by disease activity: active, recently active, or inactive.
- Prothrombin fragment 1.2 (F1.2) levels were measured using enzyme-linked immunosorbent assay (ELISA).
- Statistical analysis included Kruskal-Wallis and Wilcoxian rank sum tests to compare F1.2 levels across disease activity groups.
Main Results:
- Elevated F1.2 levels were detected in 43% of samples from active IBD phases and 63% from recently active phases.
- No elevation in F1.2 was observed in patients with inactive disease.
- Median F1.2 levels were significantly higher in both active (0.85 nM/L) and recently active (1.4 nM/L) groups compared to the inactive group (0.6 nM/L; p < 0.05).
Conclusions:
- Coagulation cascade activation is evident in patients with active and recently active IBD.
- This activation suggests an elevated risk of thrombogenesis during active disease, extending into the post-remission period.
- Patients with active IBD should be counseled to avoid thrombotic risk factors.
Objective:
To assess coagulation cascade activation as a potential index of thromboembolic risk in inflammatory bowel disease (IBD).
Study Design:
Fifty plasma samples were obtained during consecutive outpatient encounters with 29 patients (male:female = 20:9) with either Crohn's disease (CD) (n = 23) or ulcerative colitis (UC) (n = 6). Disease activity for CD was determined using the Pediatric Crohn's Disease Activity Index (PCDAI) and for UC using signs/symptoms and mucosal histology. Patients were grouped as active, recently active (not currently active but had been active within the previous 2 months), or inactive. Prothrombin fragment 1.2 (F1.2) was determined by enzyme-linked immunosorbent assay on plasma samples. Lab parameters were compared using the Kruskal-Wallis test with pairwise comparisons made using Wilcoxian rank sum test.
Results:
Forty-three percent of samples taken during active phases of disease (13 of 30) had elevated prothrombin cleavage byproduct F1.2. Similarly, five of eight encounters (63%) with recently active IBD had elevated F1.2 values. In contrast, none of the patients with inactive disease exhibited F1.2 elevation. Median F1.2 levels in both the active (0.85 nM/L) and recently active (1.4 nM/L) patient groups were greater than that of the inactive group (0.6 nM/L; p < 0.05).
Conclusions:
Evidence of coagulation cascade activation in patients with active and recently active IBD suggests an increased risk of thrombogenesis during active disease that extends for a period of time after commencement of medications to induce remission in their disease process. It may be prudent to counsel patients to avoid risk factors associated with thrombotic phenomenon around the time of active IBD.