Mo2021 The Role of Hypercoagulability in Ischemic Colitis

Abstract

Introduction: Ischemic colitis (IC) is one of the most common gastrointestinal vascular diseases in the world. IC can result from alterations in the systemic circulation or from anatomic or functional changes in the mesenteric vasculature. On the other hand, an increasing diversity of causes of IC has been reported, including hematologic disorders, thrombophilic conditions, and medications. The aim of this study is to evaluate the role of thrombophiliahypercoagulability in IC. Methods: A prospective study of 56 patients with IC (diagnosis was established from clinical, endoscopic and pathologic (biopsy proven or compatible with IC) findings) who were evaluated for protein C (PC), protein S (PS), antithrombin (AT), resistance to activated protein C (APCR), lupus anticoagulant (LA), factor V G1691Amutation (FV Leiden), prothrombin G20210A mutation, methylenetetrahydrofolate reductase (MTHFR) gene C677T & A1298C mutations and plasminogen activator inhibitor-1 (PAI1) gene 5G/4G & 4G/4G polymorphisms. The results were compared with 44 controls with known predisposing factors (including history of thrombosis, atherosclerosis, hypertension, chronic renal insufficiency, diabetes mellitus, irritable bowel syndrome, chronic constipation, history of abdominal aorta aneurysm, history of schock and autoimmune disease) but no evidence of IC. Results: Low levels of PC and AT (p= .064 & p= .022, respectively), low levels of APCR (normal: >2, p = .008) and high levels of fibrinogen (p= .0005) were recorded in IC group. Homozygotes for MTHFR A1298C & C677T mutations tended to be more in the group with IC (χ2(2)= 5.582, p = .061 & χ2(2)= 1.291, p= .525, respectively). Furthermore, the prevalences of 5G/4G & 4G/4G polymorphisms were elevated in the patients group (χ2(2)= 6.973, p = .031), while the incidence of LA positives was higher in the same group (p = .037, FET). Multivariate analysis was performed to determine the effects of prothrombotic factors in IC. 5G/4G polymorphism of PAI-1 gene (OR 12.29; 95% CI 2.2667.00), APCR (OR .089; 95% CI 0.011-0.699) and fibrinogen (OR 1.013; 95% CI 1.0031.023) were determined as predictors of IC. (FET: Fischer's Exact Test, OR: Odds ratio, CI: Confidence intervals). Conclusions: This study suggests that hypercoagulability, hereditary or acquired, plays an essential role in the manifestation of IC.