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Assessment of the procoagulant potential and associated risk factors in pregnant patients with inflammatory bowel diseases

Published:April 26, 2019DOI:https://doi.org/10.1016/j.ejim.2019.04.013

      Highlights

      • Thrombin generation was prospectively evaluated in 145 women with IBD.
      • Women were tested in different time periods prior to and during pregnancy.
      • Endogenous thrombin potential (ETP) was directly associated with the gestational age.
      • In addition, ETP was independently associated with disease activity, patients' BMI and extra-intestinal disease involvement.

      Abstract

      Objective

      Both inflammatory bowel diseases (IBDs) and pregnancy are established risk factors for thrombotic complications, thus IBD pregnant patients can be considered at even greater risk for thrombosis as compared to non IBD pregnant women. We aimed to evaluate the risk factors associated with this prothrombotic tendency among IBD women throughout gestation.

      Methods

      Women with IBD attending a multidisciplinary clinic for the preconception,antenatal and postnatal treatment were prospectively recruited during 2017–2018. Prothrombotic tendency was assessed by thrombin generation, a global marker of the activation of the coagulation system, expressed as the endogenous thrombin potential (ETP).

      Results

      Overall, 145 IBD women and 50 healthy control subjects were enrolled in this study. Body mass index (BMI) and gestational age were comparable between the groups. ETP level was significantly higher in women with IBD compared to control subjects in all time period (P < .0001). Among women with IBD, ETP level positively correlated with disease activity, as assessed by physician global assessment (P = .005), gestational age (P < .0001), extra-intestinal involvement (P = .04), C-reactive protein level (P < .0001), erythrocyte sedimentation rate (P < .0001), white blood cell count (P = .008), BMI (P = .02) and was inversely correlated with hemoglobin level (P < .0001). ETP level did not correlate with the occurrence of adverse pregnancy outcomes. In a multivariate analysis, active disease (β = 0.20, P = .009), gestational age (β = 0.45, P < .0001), extra-intestinal involvement (β = 0.17, P = .02) and BMI (β = 0.15, P = .05) retained independent predictors of high ETP levels.

      Conclusion

      As determined by thrombin generation, the procoagulant potential among IBD pregnant patients was independently associated with disease activity, BMI and extra-intestinal disease involvement.

      Keywords

      Abbreviations:

      CD (Crohn's Disease), CRP (C reactive protein), DVT (deep vein thrombosis), ESR (erythrocyte sedimentation rate), ETP (endogenous thrombin potential), GA (gestational age), IBD (inflammatory bowel diseases), PE (pulmonary embolism), PGA (physician global assessment), UC (ulcerative colitis), VTE (venous thromboembolism), WBC (white blood cell.)
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