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Review
. 2014 Oct 14;20(38):13863-78.
doi: 10.3748/wjg.v20.i38.13863.

Inflammatory bowel disease and thromboembolism

Petros Zezos  1 , Georgios Kouklakis  1 , Fred Saibil  1
Affiliations
Review

Inflammatory bowel disease and thromboembolism

Petros Zezos et al. World J Gastroenterol. .

Abstract

Patients with inflammatory bowel disease (IBD) have an increased risk of vascular complications. Thromboembolic complications, both venous and arterial, are serious extraintestinal manifestations complicating the course of IBD and can lead to significant morbidity and mortality. Patients with IBD are more prone to thromboembolic complications and IBD per se is a risk factor for thromboembolic disease. Data suggest that thrombosis is a specific feature of IBD that can be involved in both the occurrence of thromboembolic events and the pathogenesis of the disease. The exact etiology for this special association between IBD and thromboembolism is as yet unknown, but it is thought that multiple acquired and inherited factors are interacting and producing the increased tendency for thrombosis in the local intestinal microvasculature, as well as in the systemic circulation. Clinicians' awareness of the risks, and their ability to promptly diagnose and manage tromboembolic complications are of vital importance. In this review we discuss how thromboembolic disease is related to IBD, specifically focusing on: (1) the epidemiology and clinical features of thromboembolic complications in IBD; (2) the pathophysiology of thrombosis in IBD; and (3) strategies for the prevention and management of thromboembolic complications in IBD patients.

Keywords: Crohn’s disease; Endothelial dysfunction; Epidemiology; Hypercoagulability; Inflammatory bowel disease; Thromboembolism; Thrombosis; Treatment; Ulcerative colitis.

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Figures

Figure 1
Figure 1
Basic mechanisms of thrombosis (Virchow’s triad).
Figure 2
Figure 2
Inflammation and coagulation pathways are interrelated. PAF: Platelet activating factor; PAI-1: Plasminogen-activator inhibitor type-1; TGF: Transforming growth factor.
Figure 3
Figure 3
Proposed mechanism of the endothelial dysfunction in the intestinal microcirculation, in inflammatory bowel disease. (Adopted and modified from Hatoum et al[98]). ROMs: Reactive oxygen metabolites; COX: Cyclooxygenase.
See this image and copyright information in PMC

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