Objective: Inflammatory bowel disease (IBD) has an increased risk of venous thromboembolism (VTE), with factors such as hospitalization and surgery enhancing this risk. This study was aimed at evaluating rotational thrombo-elastometry (ROTEM) for assessing blood coagulation status in ulcerative colitis (UC) and determining its relationship with disease severity and response to treatment.

Methods: This was a prospective age and sex-matched study with 60 patients each in UC and irritable bowel syndrome groups, the latter being controls. Clinical details and blood investigations, including ROTEM (clotting time [CT], clot formation time [CFT], alpha angle [AA], maximum clot firmness [MCF], maximum lysis [ML]) and D-dimer, were collected, analyzed and compared between the two groups. A hypercoagulable state was defined by Kaufmann et al. as having two or more of the following: short CT and/or CFT time, increased AA and increased MA.

Results: There were 60 patients with UC (age, 38.6 ± 11.64 years; 44 males). The UC group significantly had more patients with hypercoagulable ROTEM than the control group (66.7% vs. 36.7%, p = 0.001). In UC patients with hypercoagulable ROTEM, nine patients were in remission and 31 patients had active disease. Compared to controls, CT, CFT, AA, MCF and D-dimer levels were significantly abnormal in the UC group. Among UC patients with increasing severity, only CFT, AA and D-dimer differed significantly across the groups. There were no significant differences in ROTEM values and D-dimer in patients with severe UC at admission compared to one-week post-discharge. Only hemoglobin (OR, 0.61; 95% CI, 0.38-0.98; p = 0.04) was found to be a significant independent predictor of a hypercoagulable state of active UC, on multivariate analysis.

Conclusions: More patients with UC had hypercoagulable ROTEM compared to controls, which increased with disease severity. Low hemoglobin was predictive of a hypercoagulable state in active UC.