Evidence for activation of coagulation in Crohn's disease.
Haemostatic changes in 16 patients with Crohn's disease were studied from active disease into clinical remission and beyond. Elevated concentrations of fibrinopeptide A (FpA) and prothrombin fragments F1 + 2 (F1 + 2) were found at times of both active (FpA median 3.2, range [0.3-40] ng/ml and F1 + 2 median 2.3, range [0.3-18] nm/l) and inactive disease (FpA median 2, range [0.4-40] ng/ml and F1 + 2 median 1.3, range [0.2-20) nm/l]. We also measured the physiological inhibitors of coagulation and fibrinolysis; there was no significant difference in the levels of antithrombin III, protein C or the Exner ratio between active and inactive disease. Free protein S levels were significantly lower in active disease (median 34, range 9-54 U/dl) than in remission (median 40, range 12-65 U/dl). Plasminogen activator inhibitor type 1 (PAI-1) was significantly raised in remission (median 11, range 3-32 ng/ml) when compared to active disease (median 7, range 3-42 ng/ml). The D-dimer correlated significantly with fibrinopeptide A (P < 0.001), suggesting reactive fibrinolysis in some patients. Most (35/52, 67%) samples showed evidence of persistent haemostatic activation (elevated FpA and/or F1 + 2) during phases of apparent clinical remission in Crohn's disease, a factor that is not reflected by clinical activity scores. This study supports the hypothesis that coagulation is activated in the mesenteric vasculature of patients with Crohn's disease.
Hudson
M
M
University Department of Medicine, Royal Free Hospital and School of Medicine, London, UK.
Hutton
R A
RA
Wakefield
A J
AJ
Sawyerr
A M
AM
Pounder
R E
RE
D000293:Adolescent; D000328:Adult; D000368:Aged; D001777:Blood Coagulation; D001778:Blood Coagulation Disorders / Q000097:blood / Q000209:etiology; D003424:Crohn Disease / Q000097:blood* / Q000150:complications / Q000628:therapy; D005260:Female; D005342:Fibrinolysis; D005344:Fibrinopeptide A / Q000032:analysis; D006801:Humans; D016682:Lupus Coagulation Inhibitor / Q000097:blood; D008297:Male; D008875:Middle Aged; D010446:Peptide Fragments / Q000032:analysis; D011516:Prothrombin / Q000032:analysis; D012720:Severity of Illness Index
D016682:Lupus Coagulation Inhibitor; D010446:Peptide Fragments; C045879:prothrombin fragment 1.2; D005344:Fibrinopeptide A; D011516:Prothrombin