Persistent Hypercoagulability Following Hospital Discharge in Severe Ulcerative Colitis
Despite achieving clinical improvement of colitis symptoms, patients who had been hospitalized with acute severe ulcerative colitis (ASUC) continued to show “significantly abnormal” markers of coagulation up to 8–12 weeks after initial presentation, supporting clinical observations that patients with ASUC have an elevated risk of venous thromboembolism after hospital discharge, according to authors of a recent study.
While hospitalized patients with ASUC are known to be at increased risk of venous thromboembolism (VTE), the persistence of hypercoagulability after discharge has not been well characterized. This prospective study evaluated whether prothrombotic abnormalities continue into the post-hospitalization period and the subsequent implications for thromboprophylaxis strategies.
Patients admitted with ASUC were prospectively enrolled, with serial laboratory measurements taken during hospitalization and after discharge. Coagulation parameters—including D-dimer, thrombin generation, and platelet activity—were compared with healthy controls to determine the duration and extent of abnormalities. Patients were assessed during clinical follow-up for thromboembolic outcomes.
Elevated D-dimer levels and prolonged thrombin generation persisted beyond hospitalization, the authors reported, demonstrating a sustained hypercoagulable state relative to controls. Although incidence of clinical VTE was low in this cohort, laboratory data indicated persistent risk, suggesting that standard inpatient thromboprophylaxis may be inadequate to fully mitigate post-discharge thrombotic complications.
These findings indicate that systemic prothrombotic activity in ASUC is not confined to the acute inpatient period but extends into recovery. The results raise important clinical considerations regarding the potential value of extended prophylaxis following discharge, particularly in high-risk patients. However, the optimal duration and safety profile of extended anticoagulation require validation in randomized clinical trials before incorporation into guidelines.
This prospective analysis demonstrates that patients with ASUC remain hypercoagulable following hospital discharge, underscoring the need for ongoing vigilance and possibly extended thromboprophylaxis. For clinicians managing this population, these findings highlight the importance of individualized risk assessment and close monitoring during the vulnerable postdischarge period.
Reference:
Griffiths BJ, Desborough MJR, Duijvestein M, et al. Hypercoagulation after hospital discharge in acute severe ulcerative colitis: a prospective study. Clin Gastroenterol Hepatol. 2025;23(10):1798-1807.e5.
