Hypercoagulation after Hospital Discharge in Acute Severe Ulcerative Colitis: A Prospective Study

Background & aims: Venous thromboembolism is a serious complication during and following hospitalization with acute severe ulcerative colitis (ASUC). We evaluated serial thrombotic profiles of patients with ASUC from the point of hospitalization up to 12 weeks post-discharge and compared these with control patients with quiescent UC.

Methods: Twenty-seven patients with ASUC and 25 control patients with quiescent ulcerative colitis (UC) were recruited. Thrombin generation (endogenous thrombin potential), rotational thromboelastometry (EXTEM and FIBTEM maximum clot firmness), pro-coagulant factors, anti-coagulant factors and fibrinolytic markers were assessed for those with ASUC on admission (day 1), day 5, 4 weeks and at 8 to 12 weeks. These assessments were performed on a single occasion for control patients.

Results: Endogenous thrombin potential and maximum clot firmness were significantly elevated in patients with ASUC compared to controls and remained significantly elevated for 4 weeks and for 8 to 12 weeks after admission (P< 0.05), respectively. Von Willebrand Factor (VWF) antigen, factor VIII, Clauss fibrinogen concentration and platelet count were significantly increased from presentation to 8 to 12 weeks and are likely to account for changes in the global haemostatic profile.

Conclusions: Global measures of haemostasis demonstrated that patients with ASUC were pro-thrombotic compared to controls with quiescent colitis. This difference was maintained 8 to 12 weeks after the initial presentation, supporting clinical observations that patients with ASUC have an elevated risk of VTE after hospital discharge.