Thrombosis in inflammatory bowel diseases: what’s the link?

Martina Giannotta,Elena Silvestri,Giacomo Emmi,Monica Milla,Gherardo Tapete

doi:10.1186/s12959-015-0044-2

Abstract

Inflammatory bowel disease affects more than 2 million people in Europe, with almost 20% of patients being diagnosed in pediatric age. Patients with inflammatory bowel disease are at increased risk of thromboembolic complications which may affect patients’ morbidity and mortality. The risk of the most common thromboembolic events, such as deep venous thrombosis and pulmonary embolism, are estimated to be three-fold increased compared to controls, but many other districts can be affected. Moreover, patients with ulcerative colitis and Crohn’s disease experience thromboembolic events at a younger age compared to general population. Many factors have been investigated as determinants of the pro-thrombotic tendency such as acquired risk factors or genetic and immune abnormalities, but a unique cause has not been found. Many efforts have been focused on the study of abnormalities in the coagulation cascade, its natural inhibitors and the fibrinolytic system components and both quantitative and qualitative alterations have been demonstrated. Recently the role of platelets and microvascular endothelium has been reviewed, as the possible link between the inflammatory and hemostatic process.

Highlights

Inflammatory bowel disease (IBD), whose major forms are ulcerative colitis (UC) and Crohn’s disease (CD), is a chronic inflammatory condition characterized by local and systemic inflammation predominantly affecting the gastrointestinal tract but that may be associated to numerous extra-intestinal manifestations including thrombosis
IBD affects more than 2 million people in Europe, with almost 20% of patients being diagnosed in pediatric age; in Italy over 200 thousands patients are estimated to suffer from such diseases
In CD and UC patients high values up to 4 times greater than healthy controls - of the surface CD40 ligand (CD40L), an activation markers that allows platelets to interact with a broad of immune and non immune cells with pro inflammatory consequences [25,92], and that acts as an inducer of the tissue factor (TF) mediated coagulation cascade [36] have been detected

Summary

Introduction

Inflammatory bowel disease (IBD), whose major forms are ulcerative colitis (UC) and Crohn’s disease (CD), is a chronic inflammatory condition characterized by local and systemic inflammation predominantly affecting the gastrointestinal tract but that may be associated to numerous extra-intestinal manifestations including thrombosis. Several publications reported an increased risk of thromboembolic events (TE) affecting both the venous and arterial district in UC and CD patients. This condition seems to be a characteristic of IBD, not of inflammatory or intestinal chronic disease, because it has not been. Acquired risks factors for thrombosis in IBD Many acquired factors may affect hemostatic system and contribute to the pathophysiology of VTE in IBD patients They include fluid depletion, prolonged immobilization, surgery, the use of central venous catheters, steroid therapy, oral contraceptives or hormone replacement therapy, cigarette smoking and vitamin deficiency leading to hyperhomocysteinemia [34,35].

Cigarette smoking

Findings

Conclusions