From the Guidelines
Ulcerative colitis patients are at an increased risk of stroke, and their risk of thrombosis and related mortality is doubled compared to controls, emphasizing the need for careful management of thromboembolic risk factors. The risk of thrombosis in patients with ulcerative colitis (UC) is significantly higher than in the general population, with a two-fold increase in risk compared to controls 1. This increased risk is particularly concerning during active phases of the disease, where inflammatory activity can lead to haemostatic alterations that promote blood clot formation.
Key Considerations for Management
- The management of UC should prioritize maintaining disease remission to reduce the risk of thromboembolic events, including stroke.
- Patients should adhere to prescribed medications such as mesalamine, immunomodulators, or biologics to control UC activity.
- Regular monitoring of disease activity through colonoscopies and inflammatory markers is crucial.
- Control of traditional stroke risk factors, including blood pressure, LDL cholesterol, diabetes management, smoking cessation, limited alcohol consumption, regular exercise, and a healthy diet, is also essential.
- For patients with additional risk factors, antiplatelet therapy may be considered.
Thromboprophylaxis and Treatment
- In patients at risk for thromboembolism, prevention with both mechanical thromboprophylaxis and heparin (LMWH or UFH) should be considered 1.
- The treatment of venous thromboembolism in UC patients should follow established antithrombotic therapy options, taking into account the potentially increased risk of bleeding.
- Hospitalized patients with acute severe or fulminant disease should be treated with anticoagulant prophylaxis, especially in the event of prolonged immobilization.
- Patients should be informed about risk factors for VTE, such as oral contraceptive use and long-distance travel, to further mitigate their risk.
From the Research
Ulcerative Colitis and Stroke
- Ulcerative colitis (UC) is a chronic inflammatory disease of the colon that can have extraintestinal manifestations, including an increased risk of stroke 2
- The pathogenesis of thrombosis in ulcerative colitis remains unclear, but platelet and coagulation cascade abnormalities, systemic inflammation, and the presence of other vascular risk factors are likely to play a key role in clot formation 2
- A case study reported a young woman with recurrent ischemic stroke secondary to the interaction between ulcerative colitis-related dysbalanced hemostasis and high levels of lipoprotein (a) 2
Treatment of Ulcerative Colitis
- Mesalamine is a 5-aminosalicylic acid compound that is the first-line therapy to induce and maintain clinical remission in patients with mild-to-moderate UC 3, 4
- Azathioprine and 6-mercaptopurine may be effective as maintenance therapy for patients who have failed or cannot tolerate mesalazine or sulfasalazine and for patients who require repeated courses of steroids 5
- Corticosteroids are the mainstay of treatment for hospitalized patients with acute severe ulcerative colitis (ASUC), but the addition of mesalamine to corticosteroids during hospitalization does not appear to provide additional benefit 6
Relationship between Ulcerative Colitis and Stroke
- There is limited research on the direct relationship between ulcerative colitis and stroke, but it is known that patients with UC are at increased risk of thrombotic events, including stroke 2
- Further research is needed to fully understand the relationship between ulcerative colitis and stroke, as well as the optimal treatment strategies for patients with UC who are at risk of stroke 2