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No evidence of activated blood coagulation in Crohn's disease
G Novacek1, S Kapiotis, G Moser
1Department of Internal Medicine IV, Gastroenterology and Hepatology, University of Vienna, Austria.
Insights
Thromboembolism is a complication in Crohn's disease (CD). This study found no evidence of blood coagulation activation, measured by thrombin-antithrombin III complex (TAT), suggesting TAT is not a reliable indicator of thromboembolic risk in CD patients.
Area of Science:
- Gastroenterology
- Hematology
- Immunology
Background:
- Thromboembolism is a serious complication in Crohn's disease (CD).
- Microvascular infarction of the intestinal mucosa is a potential mechanism in CD pathogenesis.
- Increased blood coagulation activation is hypothesized to contribute to thromboembolic complications in CD.
Purpose of the Study:
- To assess blood coagulation activity as a potential index of thromboembolic risk in CD.
- To evaluate thrombin-antithrombin III complex (TAT) as a marker for thromboembolic risk in CD.
Main Methods:
- Prospective evaluation of TAT plasma levels in 80 CD patients (47 inactive, 33 active) and 80 healthy controls.
- Fibrinogen, C-reactive protein, and orosomucoid were measured as parameters of blood coagulation and inflammation.
- Correlations between TAT, fibrinogen, inflammatory markers, and Crohn's Disease Activity Index (CDAI) were analyzed.
Main Results:
- Fibrinogen levels were significantly higher in active CD patients compared to inactive CD patients and controls.
- Fibrinogen levels correlated with CDAI and inflammatory markers.
- No significant difference in TAT levels was observed between active CD patients, inactive CD patients, and controls.
Conclusions:
- No evidence of blood coagulation system activation, as indicated by TAT plasma levels, was found in CD patients, even in those with active disease.
- TAT is not a suitable index for assessing thromboembolic risk in CD.
- TAT does not appear to reflect microvascular infarction as a pathogenic mechanism in CD.
Background:
Thromboembolism seems to be a significant and serious complication in Crohn's disease (CD), and multifocal microvascular infarction of the intestinal mucosa may be an important effector mechanism in the pathogenesis of CD. Therefore, it has been hypothesized that an increased activation of the blood coagulation system may favour thromboembolic complications.
Objectives:
To assess the activity of blood coagulation as a potential index of thromboembolic risk in CD using thrombin-antithrombin III complex (TAT).
Design:
Prospective evaluation of TAT.
Setting:
Out-patients at the gastroenterological department of a university hospital.
Patients:
Eighty patients with CD, 47 with inactive (Crohn's disease activity index (CDAI) < 150) and 33 with active disease, and 80 healthy controls were investigated in this study.
Methods:
TAT and fibrinogen were used as parameters of blood coagulation. C-reactive protein and orosomucoid were used as serum inflammatory parameters.
Results:
Fibrinogen was significantly higher in patients with active CD (median 535 mg/dl; interquartile range 402-620 mg/dl) than in patients with inactive CD (357 mg/dl; 300-467 mg/dl) or controls (268 mg/dl; 231-299 mg/dl). Fibrinogen correlated with CDAI, C-reactive protein and orosomucoid. TAT did not show any difference between patients with active CD (3.2 ng/ml; 2.5-4.6 ng/ml), inactive CD (3.0 ng/ml; 2.4-3.9 ng/ml) and controls (3.1 ng/ml; 2.3-3.6 ng/ml). Correspondingly, TAT correlated neither with serum inflammatory parameters and CDAI nor with fibrinogen.
Conclusion:
We could not find evidence of activation of the blood coagulation system as determined by TAT plasma levels in CD, not even in patients with active disease. TAT is not, therefore, a potential index of thromboembolic risk in CD and of microvascular infarction as an effector mechanism in the pathogenesis of CD.