Альманах клинической медицины. 2017; 45: 423-428
Клинический случай наследственной тромбофилии у больной язвенным колитом
https://doi.org/10.18786/2072-0505-2017-45-5-423-428Аннотация
Приведено описание пациентки 24 лет, поступившей в клинику с высокой активностью язвенного колита, ассоциированного с латентной наследственной тромбофилией, активизация которой была вызвана обострением язвенного колита и применением местной стероидной терапии. Пациентке назначена комбинированная терапия системными глюкокортикостероидами, адалимумабом и антикоагулянтами. Подчеркивается необходимость мультидисциплинарного подхода в лечении пациентки. Приведенный клинический случай демонстрирует, что больным язвенным колитом с высоким риском тромбообразования возможно безопасное назначение антикоагулянтов для профилактики тромбоэмболических осложнений под постоянным наблюдением, контролем коагулограммы и тромбоэластограммы. Обсуждается необходимость создания четких рекомендаций по определению тактики лечения пациентов с воспалительными заболеваниями кишечника, у которых развиваются коагулопатии и тромбоэмболические осложнения.
Список литературы
1. Algahtani FH, Farag YM, Aljebreen AM, Alazzam NA, Aleem AS, Jabri FF, Rajab MH, Shoukri MM. Thromboembolic events in patients with inflammatory bowel disease. Saudi J Gastroenterol. 2016;22(6):423–7. doi: 10.4103/1319-3767.195558.
2. Yoshida H, Granger DN. Inflammatory bowel disease: a paradigm for the link between coagulation and inflammation. Inflamm Bowel Dis. 2009;15(8):1245–55. doi: 10.1002/ibd.20896.
3. Nguyen GC, Sam J. Rising prevalence of venous thromboembolism and its impact on mortality among hospitalized inflammatory bowel disease patients. Am J Gastroenterol. 2008;103(9):2272–80. doi: 10.1111/j.1572-0241.2008.02052.x.
4. Giannotta M, Tapete G, Emmi G, Silvestri E, Milla M. Thrombosis in inflammatory bowel diseases: what's the link? Thromb J. 2015;13:14. doi: 10.1186/s12959-015-0044-2.
5. Lee LC, Spittell JA Jr, Sauer WG, Owen CA Jr, Thompson JH Jr. Hypercoagulability associated with chronic ulcerative colitis: changes in blood coagulation factors. Gastroenterology. 1968;54(1):76–85. doi: http://dx.doi.org/10.1016/S0016-5085(68)80041-1.
6. Lam A, Borda IT, Inwood MJ, Thomson S. Coagulation studies in ulcerative colitis and Crohn's disease. Gastroenterology. 1975;68(2): 245–51. doi: http://dx.doi.org/10.1016/S0016-5085(75)80005-9.
7. Lake AM, Stauffer JQ, Stuart MJ. Hemostatic alterations in inflammatory bowel disease: response to therapy. Am J Dig Dis. 1978;23(10):897–902.
8. Souto JC, Martínez E, Roca M, Mateo J, Pujol J, González D, Fontcuberta J. Prothrombotic state and signs of endothelial lesion in plasma of patients with inflammatory bowel disease. Dig Dis Sci. 1995;40(9):1883–9. doi: https://doi.org/10.1007/BF02208650.
9. Heneghan MA, Cleary B, Murray M, O'Gorman TA, McCarthy CF. Activated protein C resistance, thrombophilia, and inflammatory bowel disease. Dig Dis Sci. 1998;43(6):1356–61. doi: https://doi.org/10.1023/A:1018840715357.
10. Chamouard P, Grunebaum L, Wiesel ML, Frey PL, Wittersheim C, Sapin R, Baumann R, Cazenave JP. Prothrombin fragment 1 + 2 and thrombin-antithrombin III complex as markers of activation of blood coagulation in inflammatory bowel diseases. Eur J Gastroenterol Hepatol. 1995;7(12):1183–8.
11. Jorens PG, Hermans CR, Haber I, Kockx MM, Vermylen J, Parizel GA. Acquired protein C and S deficiency, inflammatory bowel disease and cerebral arterial thrombosis. Blut. 1990;61(5):307–10.
12. Aadland E, Odegaard OR, Røseth A, Try K. Free protein S deficiency in patients with Crohn's disease. Scand J Gastroenterol. 1994;29(4):333–5. doi: https://doi.org/10.3109/00365529409094844.
13. Owczarek D, Cibor D, Głowacki MK, Rodacki T, Mach T. Inflammatory bowel disease: epidemiology, pathology and risk factors for hypercoagulability. World J Gastroenterol. 2014;20(1):53–63. doi: 10.3748/wjg.v20.i1.53.
14. Yuhara H, Steinmaus C, Corley D, Koike J, Igarashi M, Suzuki T, Mine T. Meta-analysis: the risk of venous thromboembolism in patients with inflammatory bowel disease. Aliment Pharmacol Ther. 2013;37(10):953–62. doi: 10.1111/apt.12294.
Almanac of Clinical Medicine. 2017; 45: 423-428
A clinical case of hereditary thrombophilia in a patient with ulcerative colitis
https://doi.org/10.18786/2072-0505-2017-45-5-423-428Abstract
We present a clinical case of a 24-year old female patient who was hospitalized with high active ulcerative colitis associated with latent hereditary thrombophilia uncontrolled due to the exacerbation of ulcerative colitis and local steroid treatment. The patient was treated with combination of systemic steroids, adalimumab and anticoagulants. We emphasize the necessity of the multidisciplinary approach to her treatment. The clinical case demonstrates the possibility of safe use of anticoagulants to prevent thromboembolic complications in patients with ulcerative colitis and high risk of thrombus formation, under careful monitoring of coagulation parameters and thromboelastography. We discuss the need in clear guidelines to determine treatment strategy for patients with inflammatory bowel diseases, coagulopathies and thromboembolic complications.
References
1. Algahtani FH, Farag YM, Aljebreen AM, Alazzam NA, Aleem AS, Jabri FF, Rajab MH, Shoukri MM. Thromboembolic events in patients with inflammatory bowel disease. Saudi J Gastroenterol. 2016;22(6):423–7. doi: 10.4103/1319-3767.195558.
2. Yoshida H, Granger DN. Inflammatory bowel disease: a paradigm for the link between coagulation and inflammation. Inflamm Bowel Dis. 2009;15(8):1245–55. doi: 10.1002/ibd.20896.
3. Nguyen GC, Sam J. Rising prevalence of venous thromboembolism and its impact on mortality among hospitalized inflammatory bowel disease patients. Am J Gastroenterol. 2008;103(9):2272–80. doi: 10.1111/j.1572-0241.2008.02052.x.
4. Giannotta M, Tapete G, Emmi G, Silvestri E, Milla M. Thrombosis in inflammatory bowel diseases: what's the link? Thromb J. 2015;13:14. doi: 10.1186/s12959-015-0044-2.
5. Lee LC, Spittell JA Jr, Sauer WG, Owen CA Jr, Thompson JH Jr. Hypercoagulability associated with chronic ulcerative colitis: changes in blood coagulation factors. Gastroenterology. 1968;54(1):76–85. doi: http://dx.doi.org/10.1016/S0016-5085(68)80041-1.
6. Lam A, Borda IT, Inwood MJ, Thomson S. Coagulation studies in ulcerative colitis and Crohn's disease. Gastroenterology. 1975;68(2): 245–51. doi: http://dx.doi.org/10.1016/S0016-5085(75)80005-9.
7. Lake AM, Stauffer JQ, Stuart MJ. Hemostatic alterations in inflammatory bowel disease: response to therapy. Am J Dig Dis. 1978;23(10):897–902.
8. Souto JC, Martínez E, Roca M, Mateo J, Pujol J, González D, Fontcuberta J. Prothrombotic state and signs of endothelial lesion in plasma of patients with inflammatory bowel disease. Dig Dis Sci. 1995;40(9):1883–9. doi: https://doi.org/10.1007/BF02208650.
9. Heneghan MA, Cleary B, Murray M, O'Gorman TA, McCarthy CF. Activated protein C resistance, thrombophilia, and inflammatory bowel disease. Dig Dis Sci. 1998;43(6):1356–61. doi: https://doi.org/10.1023/A:1018840715357.
10. Chamouard P, Grunebaum L, Wiesel ML, Frey PL, Wittersheim C, Sapin R, Baumann R, Cazenave JP. Prothrombin fragment 1 + 2 and thrombin-antithrombin III complex as markers of activation of blood coagulation in inflammatory bowel diseases. Eur J Gastroenterol Hepatol. 1995;7(12):1183–8.
11. Jorens PG, Hermans CR, Haber I, Kockx MM, Vermylen J, Parizel GA. Acquired protein C and S deficiency, inflammatory bowel disease and cerebral arterial thrombosis. Blut. 1990;61(5):307–10.
12. Aadland E, Odegaard OR, Røseth A, Try K. Free protein S deficiency in patients with Crohn's disease. Scand J Gastroenterol. 1994;29(4):333–5. doi: https://doi.org/10.3109/00365529409094844.
13. Owczarek D, Cibor D, Głowacki MK, Rodacki T, Mach T. Inflammatory bowel disease: epidemiology, pathology and risk factors for hypercoagulability. World J Gastroenterol. 2014;20(1):53–63. doi: 10.3748/wjg.v20.i1.53.
14. Yuhara H, Steinmaus C, Corley D, Koike J, Igarashi M, Suzuki T, Mine T. Meta-analysis: the risk of venous thromboembolism in patients with inflammatory bowel disease. Aliment Pharmacol Ther. 2013;37(10):953–62. doi: 10.1111/apt.12294.
