Increased thrombin generation in inflammatory bowel diseases.
BACKGROUND
Inflammatory bowel diseases (IBD) are characterized by an increased thrombotic risk of uncertain etiology. Endogenous thrombin potential (ETP), a parameter of the thrombin generation curve, represents a new tool in the evaluation of thrombotic and bleeding disorders.


OBJECTIVE
To study ETP in IBD patients and to correlate the results with clinical and biochemical features.


METHODS
Seventy-four IBD patients (37 ulcerative colitis and 37 Crohn's disease) and 74 sex- and age-matched healthy individuals. ETP was measured upon activation of coagulation with small amounts of tissue factor and phospholipids in the presence or absence of thrombomodulin; results were expressed as nM thrombin.minutes.


RESULTS
Mean+/-SD ETP values were significantly higher in patients (1,499+/-454) than controls (1,261+/-385) (p<0.001) only when the test was performed in the presence of thrombomodulin. ETP evaluated as ratio (with/without thrombomodulin), taken as an index of hypercoagulability, was significantly higher in patients (0.69+/-0.14) than controls (0.62+/-0.18) (p<0.006). Patients with increased C-reactive protein (CRP) had significantly higher mean ETP (1,721+/-458) than those with normal CRP (1,357+/-394) or controls (1,261+/-385) (p<0.001). Patients who at the time of blood sampling were classified as having a clinically active disease had ETP higher than those who were quiescent (1,655+/-451 versus 1,388+/-427, p<0.001) or controls (1,261+/-385, p<0.001).


CONCLUSIONS
ETP measured in the presence of thrombomodulin or as ratio (with/without thrombomodulin) is increased in IBD patients, mainly in those with increased CRP or active disease. It may be considered as a candidate test for prospective studies aimed at assessing the risk of thrombosis in IBD patients.
Saibeni
Simone
S
Department of Internal Medicine and Hepatology, Azienda Ospedaliera Fatebenefratelli e Oftalmico, Milan, Italy.
Saladino
Valeria
V
Chantarangkul
Veena
V
Villa
Federica
F
Bruno
Savino
S
Vecchi
Maurizio
M
de Franchis
Roberto
R
Sei
Cinzia
C
Tripodi
Armando
A
D000328:Adult; D002097:C-Reactive Protein / Q000378:metabolism; D016022:Case-Control Studies; D003093:Colitis, Ulcerative / Q000097:blood; D003424:Crohn Disease / Q000097:blood; D005169:Factor VIII / Q000032:analysis; D005260:Female; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000097:blood*; D008297:Male; D008875:Middle Aged; D010743:Phospholipids / Q000097:blood; D011446:Prospective Studies; D013917:Thrombin / Q000378:metabolism*; D018180:Thrombomodulin / Q000097:blood; D013925:Thromboplastin / Q000032:analysis
D010743:Phospholipids; D018180:Thrombomodulin; D005169:Factor VIII; D002097:C-Reactive Protein; D013925:Thromboplastin; D013917:Thrombin