Thromboembolism and resistance to activated protein C in patients with inflammatory bowel disease

OBJECTIVE: Thromboembolic events are serious complications in patients with inflammatory bowel disease (IBD). Resistance of factor V to degradation by activated protein C (APC) is a major cause for venous thrombosis and is fo und in approximately 30% of patients with thromboembolism. The aim of the p resent study was to assess the prevalence of APC resistance and clinical ri sk factors in patients with IBD. METHODS: One-hundred-two patients with IBD (64 women and 38 men; median age , 35 yr; range, 17-77 yr; 77 with Crohn's disease, 25 with ulcerative colit is) and 102 gender- and age-matched healthy control subjects were investiga ted prospectively for the presence of APC resistance. None of the healthy c ontrols but 16 patients with IBD had a history of thromboembolism. RESULTS: Patients with IBD and thromboembolism were young, with a median ag e of 37 yr (range, 17-61 yr). Five (31.3%) of them had APC resistance, whic h was more common than in patients with IBD without thromboembolism (7%) an d in controls (5.9%) (p < 0.01). Three patients had two thromboembolic even ts, the other 13 each had one. Deep vein thrombosis of the leg and pulmonar y emboli were the most common thromboembolic complications (84.2%). Active disease, fistula, or bowel stenosis were found in 10 (52.6%) of 19 thromboe mbolic events; in three (15.8%) cases thromboembolism happened postoperativ ely. CONCLUSIONS: APC resistance is not associated with IBD but, when present, i ncreases the risk of thromboembolism. Patients with IBD and thromboembolism are mostly young and clinical risk factors can be found in one-half of cas es. (Am J Gastroenterol 1999;94:685-690. (C) 1999 by Am. Cell. of Gastroent erology).