In the excellent practice-oriented article on ulcerative colitis, Ford and colleagues overlooked the role of thrombosis prevention in acute flares of ulcerative colitis. Thrombosis as a triggering factor for this condition is well-established . The link between inflammation and coagulation in inflammatory bowel disease, as a whole, is being explored in the trials where heparin is being tried to modulate the patient outcome . Beyond the benefits at the molecular level from influencing mucosal inflammation, anticoagulant treatment is paramount in any flare-ups since ulcerative colitis is a very strong risk factor for thrombosis, even in the absence of hereditary thrombophilia [3, 4].
In recent years, another dilemma has been raised where pregnancy morbidities are frequently noted, despite successful outcomes from the continued use of 5-aminosalicylates. Whether thrombosis is responsible for the high risk of pregnancy complications has not been systematically studied, although antithrombotic prophylaxis should be given serious consideration to prevent venous thromboembolism in this setting, due to multiple risk factors of inflammatory disease and the procoagulant pregnant state. It will be an interesting prospect whether routine use of such prophylaxis may translate to better pregnancy outcomes.
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2.Scaldaferri F, Lancellotti S, Pizzoferrato M, De Cristofaro R. Haemostatic system in inflammatory bowel diseases: new players in gut inflammation. World J Gastroenterol. 2011 Feb 7;17(5):594-608
3.Miehsler W, Reinisch W, Valic E, Osterode W, Tillinger W, Feichtenschlager T, Grisar J, Machold K, Scholz S, Vogelsang H. Is inflammatory bowel disease an independent and disease specific risk factor for thromboembolism?. Gut. 2004;53:542-548.
4. Grainge MJ, West J, Card TR. Venous thromboembolism during active disease and remission in inflammatory bowel disease: a cohort study. Lancet. 2010 Feb 20;375(9715):657-63