General

Is there any association of ulcerative colitis with thromboembolic events???

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5 Sep 2016 - General
 

When patient with flare of ulcerative colitis admitted to hospital, with the symptoms of on-going bloody diarrhoea, and drop in haemoglobullin (Hb) level, would the admitting doctor considered to put the patient on prophylactic dose of low molecular weight heparin (either enoxaprin or tinzaparin prophylactic dose) ??? Would this approach aggravating further or more blood loss ?? Actaully, all the patients with acute flare of ulcerative colitis / inflammatory bowel disease should be prescribed prophylatic dose of low molecular weight heparin. This is because patient with ulcerative colitis / inflammatory bowel disease are at an increased risk of thromboembolic events, most commonly deep venous thrombosis of the lower limbs.

I will totally agree that some specialty related disease condition may not be a common encounter for each and every doctor working in healthcare sector. But, when we are encountering something that we are unsure about, we should always look up for some guideline or seek for expert opinion in that particular field. I would say UpToDate is one of the best place to look up for anything that we are unsure about during our daily clinical work. If not, they can always seek for expert opinion, like ask...
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You Yi Hong Yeah, when there is clear evidence on the efficacy of a drug it should not be disregarded. I think the ones who are being cautious are the ones who do not know proper medicine. But can't entirely put the blame on them because there are some disease that are uncommon in someone's field of practice so they do not stay updated 100 percent about each of those diseases. Now that I am aware of the l...
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Ya Theekshana Abayawickrama , there are a lot of doctors are quite cautious or reluctant to prescribe prophylactic low molecular weight heparin in patients who are having on-going lower gastrointestinal bleeding (bloody diarrhoea). It might seem to be a paradoxical idea of giving low molecular weight heparin in bleeding patient, as the fear of causing more and more bleeding. This is probably the reason sometime pa...
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I also haven't had the chance to see the acute management of an active flare-up of ulcerative colitis. This bit of information is new to me so thanks for sharing. In the general point of view of doctors, low molecular weight heparin are contraindicated when the patient is having acute bleeding. However there are instances where we consider administration of low molecular weight heparin, for example a patient with non ST elevation myocardial infarction who also has upper gastrointestinal blee...
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I also haven't had the chance to see the acute management of an active flare-up of ulcerative colitis. This bit of information is new to me so thanks for sharing. In the general point of view of doctors, low molecular weight heparin are contraindicated when the patient is having acute bleeding. However there are instances where we consider administration of low molecular weight heparin, for example a patient with non ST elevation myocardial infarction who also has upper gastrointestinal blee...
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Yes, Kathleen Peralta the statement you quoted is definitely correct. The risk of haemorrhage by giving the prophylactic dose of low molecular weight heparin is negligible. The risk of thromboembolic events in the patients with acute flare of colitis is high, and hence we should always give prophylactic low molecular weight heparin to prevent deep vein thrombosis or pulmonary embolism, as per stated in the clini...
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This is a good point for discussion. Haemorrhage is normally the main concern when treating patients with inflammatory bowel disease with Heparin. I would like to quote a statement from an ebook which states that "In view of the increased risk of thromboembolic events in IBD, and the lack of adverse events related to use of heparin, in particular LMWH, it is recommended that prophylactic LMWH should be given to all hospitalised patients with IBD". I haven't encountered this situat...
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