Persistent activation of coagulation and fibrinolysis after treatment of active ulcerative colitis.
OBJECTIVE
Haemostatic changes may be involved in the pathogenesis and progression of ulcerative colitis. We studied longitudinally inflammatory and haemostatic parameters in patients treated for severe ulcerative colitis.


METHODS
We carried out a descriptive study of longitudinal blood measurements in patients with severe ulcerative colitis from one large regional hospital.


METHODS
Nineteen patients with severe ulcerative colitis were assessed by an endoscopic score and a patient score at baseline. Patients were assessed by patient scores during treatment at scheduled intervals. At each visit, inflammatory and haemostatic parameters were determined.


RESULTS
At baseline, the erythrocyte sedimentation rate, C-reactive protein, leucocyte and granulocyte count, thrombin-antithrombin complexes, prothrombin fragment 1+2, fibrinogen and degradation products of fibrinogen and fibrin were increased in patients when compared with controls, whereas albumin concentration and factor XIII activity were significantly lower. Antithrombin activity was normal. During treatment, the median patient score diminished significantly from 12 to 4.5 points after 2 weeks, decreased further to 4 points after 4 weeks and remained below 4 points throughout the remaining study period. Inflammation parameters returned to within the reference range in two patients after 4 weeks, whereas the coagulation markers prothrombin fragment 1+2 and thrombin-antithrombin complexes returned to normal values after 8 weeks and 24 weeks, respectively. In contrast with markers of inflammation, slightly increased concentrations of the degradation products of both fibrinogen and fibrin were found for almost 1 year, which indicated low-grade activation of coagulation and fibrinolysis.


CONCLUSIONS
These results are compatible with a condition of persistent hypercoagulation in patients with ulcerative colitis who are in clinical remission. Persistent hypercoagulation may contribute to the clinical course of ulcerative colitis.
van Bodegraven
Ad A
AA
Department of Gastroenterology, Academic Hospital Free University, PO Box 7057, 1007 MB Amsterdam, The Netherlands. v.Bodegraven@vumc.nl
Schoorl
Marianne
M
Linskens
Ronald K
RK
Bartels
Piet C
PC
Tuynman
Hans A
HA
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000990:Antithrombin III; D001777:Blood Coagulation; D002097:C-Reactive Protein / Q000032:analysis; D003093:Colitis, Ulcerative / Q000503:physiopathology*; D005260:Female; D005342:Fibrinolysis; D006801:Humans; D008297:Male; D008875:Middle Aged; D010447:Peptide Hydrolases / Q000097:blood
C046193:antithrombin III-protease complex; D000990:Antithrombin III; D002097:C-Reactive Protein; D010447:Peptide Hydrolases