PDF herunterladen
CC BY 4.0 · TH Open 2022; 06(02): e147-e153
DOI: 10.1055/a-1827-7464
Original Article

High Factor VIII Levels and Recurrent Thromboembolism in Patients with and without Inflammatory Bowel Disease: A Retrospective Comparative Study

G E. Eagle
1   Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
,
Sam Schulman 
2   Department of Medicine, Thrombosis and Atherosclerosis Research Institute, McMaster University, Hamilton, Ontario, Canada
3   Department of Obstetrics and Gynecology, I. M. Sechenov First Moscow State Medical University, Moscow, Russia
› Institutsangaben
› Weitere Informationen
   Lizenzen und Reprints

Abstract

Background The natural course of elevated factor VIII (FVIII) in patients with venous thromboembolism (VTE) and with or without inflammatory bowel disease (IBD) is not well described. Furthermore, the data on effectiveness and safety of extended anticoagulation in these patients are limited.

Methods We performed a retrospective chart review of all patients with VTE who had an elevated FVIII level (>1.5 IU/mL) during a period of 16 years. FVIII levels, duration of anticoagulation, recurrent thromboembolic events, and bleeding requiring hospitalization were captured and compared between patients with and without IBD.

Results Fourteen patients with IBD and 66 without IBD were followed for 8.0 years (standard deviation [SD] =  ±  3.5) and 5.6 years (SD =  ±  5.1), respectively. Among the 41 patients with repeat levels, FVIII remained elevated in most patients. None of the IBD patients had thromboembolic events or major bleeding during a mean of 5.6 years (SD =  ±  5.1) of anticoagulation. Three of five IBD patients who stopped anticoagulation had thromboembolic events at a median of 9 months after stopping, observed event rate of 12 per 100 patient-years. For the 66 non-IBD patients, the event rates of thromboembolism on and off anticoagulation were 1.6 and 7.2 per 100 patient-years, respectively, and of major bleeding on anticoagulation 0.8 per 100 patient-years.

Conclusion Elevated FVIII in patients with VTE is often a persistent risk factor. The cohort with VTE and elevated FVIII that we analyzed appeared to have a favorable benefit/risk ratio of extended anticoagulation.

Keywords

inflammatory bowel disease - venous thromboembolism - factor VIII - oral anticoagulation - bleeding


Publikationsverlauf

Eingereicht: 26. Januar 2022

Angenommen: 04. April 2022

Accepted Manuscript online:
18. April 2022

Artikel online veröffentlicht:
13. Juni 2022

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Rietveld IM, Lijfering WM, le Cessie S. et al. High levels of coagulation factors and venous thrombosis risk: strongest association for factor VIII and von Willebrand factor. J Thromb Haemost 2019; 17 (01) 99-109
    CrossrefPubMedGoogle Scholar
  • 2 Koster T, Blann AD, Briët E, Vandenbroucke JP, Rosendaal FR. Role of clotting factor VIII in effect of von Willebrand factor on occurrence of deep-vein thrombosis. Lancet 1995; 345 (8943): 152-155
    CrossrefPubMedGoogle Scholar
  • 3 Cosmi B, Legnani C, Cini M, Favaretto E, Palareti G. D-dimer and factor VIII are independent risk factors for recurrence after anticoagulation withdrawal for a first idiopathic deep vein thrombosis. Thromb Res 2008; 122 (05) 610-617
    CrossrefPubMedGoogle Scholar
  • 4 Kyrle PA, Minar E, Hirschl M. et al. High plasma levels of factor VIII and the risk of recurrent venous thromboembolism. N Engl J Med 2000; 343 (07) 457-462
    CrossrefPubMedGoogle Scholar
  • 5 Wells PS, Langlois NJ, Webster MA, Jaffey J, Anderson JA. Elevated factor VIII is a risk factor for idiopathic venous thromboembolism in Canada - is it necessary to define a new upper reference range for factor VIII?. Thromb Haemost 2005; 93 (05) 842-846
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 6 Jenkins PV, Rawley O, Smith OP, O'Donnell JS. Elevated factor VIII levels and risk of venous thrombosis. Br J Haematol 2012; 157 (06) 653-663
    CrossrefPubMedGoogle Scholar
  • 7 Simioni P, Cagnin S, Sartorello F. et al. Partial F8 gene duplication (factor VIII Padua) associated with high factor VIII levels and familial thrombophilia. Blood 2021; 137 (17) 2383-2393
    CrossrefPubMedGoogle Scholar
  • 8 Mori K, Watanabe H, Hiwatashi N, Sugai K, Goto Y. Studies on blood coagulation in ulcerative colitis and Crohn's disease. Tohoku J Exp Med 1980; 132 (01) 93-101
    CrossrefPubMedGoogle Scholar
  • 9 Lam A, Borda IT, Inwood MJ, Thomson S. Coagulation studies in ulcerative colitis and Crohn's disease. Gastroenterology 1975; 68 (02) 245-251
    CrossrefPubMedGoogle Scholar
  • 10 Kume K, Yamasaki M, Tashiro M, Yoshikawa I, Otsuki M. Activations of coagulation and fibrinolysis secondary to bowel inflammation in patients with ulcerative colitis. Intern Med 2007; 46 (17) 1323-1329
    CrossrefPubMedGoogle Scholar
  • 11 Lee LC, Spittell Jr. JA, Sauer WG, Owen Jr. CA, Thompson Jr JH. Hypercoagulability associated with chronic ulcerative colitis: changes in blood coagulation factors. Gastroenterology 1968; 54 (01) 76-85
    CrossrefPubMedGoogle Scholar
  • 12 Lake AM, Stauffer JQ, Stuart MJ. Hemostatic alterations in inflammatory bowel disease: response to therapy. Am J Dig Dis 1978; 23 (10) 897-902
    CrossrefPubMedGoogle Scholar
  • 13 Zielen S, Bender SW, Kreuz W, Posselt HG, Solem E, Scharrer I. Crohn's disease activity: assessment by factor VIII coagulation proteins. J Pediatr Gastroenterol Nutr 1985; 4 (05) 730-734
    CrossrefPubMedGoogle Scholar
  • 14 Kamphuisen PW, Eikenboom JC, Vos HL. et al. Increased levels of factor VIII and fibrinogen in patients with venous thrombosis are not caused by acute phase reactions. Thromb Haemost 1999; 81 (05) 680-683
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 15 Rohm TV, Meier DT, Olefsky JM, Donath MY. Inflammation in obesity, diabetes, and related disorders. Immunity 2022; 55 (01) 31-55
    CrossrefPubMedGoogle Scholar
  • 16 Mertens I, Van Gaal LF. Obesity, haemostasis and the fibrinolytic system. Obes Rev 2002; 3 (02) 85-101
    CrossrefPubMedGoogle Scholar
  • 17 Simion C, Campello E, Bensi E. et al. Use of glucocorticoids and risk of venous thromboembolism: a narrative review. Semin Thromb Hemost 2021; 47 (06) 654-661
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 18 Khan F, Tritschler T, Kimpton M. et al. Long-term risk of recurrent venous thromboembolism among patients receiving extended oral anticoagulant therapy for first unprovoked venous thromboembolism: A systematic review and meta-analysis. J Thromb Haemost 2021; 19 (11) 2801-2813
    CrossrefPubMedGoogle Scholar
  • 19 Khan F, Rahman A, Carrier M. et al; MARVELOUS Collaborators. Long term risk of symptomatic recurrent venous thromboembolism after discontinuation of anticoagulant treatment for first unprovoked venous thromboembolism event: systematic review and meta-analysis. BMJ 2019; 366: l4363
    CrossrefPubMedGoogle Scholar
  • 20 Ortel TL, Neumann I, Ageno W. et al. American Society of Hematology 2020 guidelines for management of venous thromboembolism: treatment of deep vein thrombosis and pulmonary embolism. Blood Adv 2020; 4 (19) 4693-4738
    CrossrefPubMedGoogle Scholar
  • 21 Stevens SM, Woller SC, Baumann Kreuziger L. et al. Executive summary: antithrombotic therapy for VTE disease: Second update of the CHEST guideline and expert panel report. Chest 2021; 160 (06) 2247-2259
    CrossrefPubMedGoogle Scholar
  • 22 Coremans L, Strubbe B, Peeters H. Venous thromboembolism in patients with inflammatory bowel disease: review of literature and practical algorithms. Acta Gastroenterol Belg 2021; 84 (01) 79-85
    CrossrefPubMedGoogle Scholar
  • 23 Harbord M, Annese V, Vavricka SR. et al; European Crohn's and Colitis Organisation. The first European evidence-based consensus on extra-intestinal manifestations in inflammatory bowel disease. J Crohn's Colitis 2016; 10 (03) 239-254
    CrossrefPubMedGoogle Scholar
  • 24 Scharrer S, Primas C, Eichinger S. et al; Austrian IBD Study Group. Inflammatory bowel disease and risk of major bleeding during anticoagulation for venous thromboembolism. Inflamm Bowel Dis 2021; 27 (11) 1773-1783
    CrossrefPubMedGoogle Scholar