title: Determination of prothrombin activation fragments in young patients with inflammatory bowel disease.
abstract: OBJECTIVE
  To assess coagulation cascade activation as a potential index of thromboembolic risk in inflammatory bowel disease (IBD).
  
  
  METHODS
  Fifty plasma samples were obtained during consecutive outpatient encounters with 29 patients (male:female = 20:9) with either Crohn's disease (CD) (n = 23) or ulcerative colitis (UC) (n = 6). Disease activity for CD was determined using the Pediatric Crohn's Disease Activity Index (PCDAI) and for UC using signs/symptoms and mucosal histology. Patients were grouped as active, recently active (not currently active but had been active within the previous 2 months), or inactive. Prothrombin fragment 1.2 (F1.2) was determined by enzyme-linked immunosorbent assay on plasma samples. Lab parameters were compared using the Kruskal-Wallis test with pairwise comparisons made using Wilcoxian rank sum test.
  
  
  RESULTS
  Forty-three percent of samples taken during active phases of disease (13 of 30) had elevated prothrombin cleavage byproduct F1.2. Similarly, five of eight encounters (63%) with recently active IBD had elevated F1.2 values. In contrast, none of the patients with inactive disease exhibited F1.2 elevation. Median F1.2 levels in both the active (0.85 nM/L) and recently active (1.4 nM/L) patient groups were greater than that of the inactive group (0.6 nM/L; p < 0.05).
  
  
  CONCLUSIONS
  Evidence of coagulation cascade activation in patients with active and recently active IBD suggests an increased risk of thrombogenesis during active disease that extends for a period of time after commencement of medications to induce remission in their disease process. It may be prudent to counsel patients to avoid risk factors associated with thrombotic phenomenon around the time of active IBD.
authors.affiliation: Department of Pediatrics, University of Nebraska Medical Center, Omaha 68198-5160, USA.
authors.forename: C J
authors.initials: CJ
authors.lastname: Smith
authors.forename: W D
authors.initials: WD
authors.lastname: Haire
authors.forename: S S
authors.initials: SS
authors.lastname: Kaufman
authors.forename: D R
authors.initials: DR
authors.lastname: Mack
mesh_terms: D000293:Adolescent; D001777:Blood Coagulation; D002648:Child; D003093:Colitis, Ulcerative / Q000097:blood* / Q000150:complications; D003424:Crohn Disease / Q000097:blood* / Q000150:complications; D005260:Female; D006801:Humans; D008297:Male; D010446:Peptide Fragments / Q000032:analysis*; D011516:Prothrombin / Q000032:analysis*; D012307:Risk Factors; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D013923:Thromboembolism / Q000097:blood / Q000209:etiology
chemical_list: D010446:Peptide Fragments; C045879:prothrombin fragment 1.2; D011516:Prothrombin