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Two thrombotic complications in a patient with active ulcerative colitis
R K Gonera1, T P Timmerhuis, A C Leyten
1Department of Internal Medicine, St. Elisabeth Hospital, Tilburg, Netherlands.
The Netherlands Journal of Medicine
|February 1, 1997
Summary
Active ulcerative colitis can cause blood clots in the brain and legs due to temporary resistance to activated protein C (APC). Colectomy normalized APC resistance, suggesting a link between colitis activity and thrombophilia.
Area of Science:
- Vascular Medicine
- Gastroenterology
- Hematology
Background:
- Ulcerative colitis (UC) is a chronic inflammatory bowel disease.
- Thrombophilia, an increased tendency to form blood clots, can occur in patients with active UC.
- The underlying mechanisms of UC-associated thrombophilia are not fully understood.
Observation:
- A 30-year-old female patient presented with simultaneous cerebral venous thrombosis and deep vein thrombosis (DVT).
- These thrombotic events coincided with an exacerbation of her ulcerative colitis.
- Laboratory tests revealed transient functional activated protein C (APC) resistance and mild hyperhomocysteinemia.
Findings:
- The patient exhibited functional APC resistance, a condition where the blood is less responsive to the anticoagulant effects of APC.
- Notably, the Factor V Leiden mutation, a common genetic cause of inherited thrombophilia, was absent.
- Following a colectomy (surgical removal of the colon), her APC ratio normalized, indicating the resolution of the resistance.
Implications:
- These findings suggest that active ulcerative colitis can induce a temporary prothrombotic state.
- Transient APC resistance and mild hyperhomocysteinemia may contribute to the thrombophilia observed in some UC patients.
- Understanding these mechanisms could lead to improved risk stratification and management of thromboembolic events in inflammatory bowel disease.