A case of ischemic colitis associated with factor V Leiden mutation: successful treatment with anticoagulation

Ischaemic colitis: uncertainty in diagnosis, pathophysiology and management

“…have suggested routine screening for thrombophilia and anticoagulation treatment if a prothrombotic condition is detected (7,19,28,29). No prospective or case-controlled trials of anticoagulation as treatment or prevention of recurrence have been performed.…”

“…Given the similar pathophysiology of IC, further research into potential benefits of antiplatelets may be warranted. IC is associated with high rates of demonstrable thrombophilia and the role of anticoagulation of these patients has only been suggested in case studies (7,19,29). O'Neill and Yalamarthi recommend heparin prophylaxis as a component of conservative management in these patients, however there is a lack of prospective evidence for it's use (15,53).…”

Clinical approach to colonic ischemia

“…Even if we detect thrombophilia, nobody yet knows what the appropriate medical treatment should be. Although some cases of ischemic colitis with associated thrombophilia have been successfully treated with anticoagulants, 28,29 the benefit of diagnosing and treating a hypercoagulable state in ischemic colitis is still unproven. Therefore, oral anticoagulation should be used only in those in whom a hypercoagulable state is the most likely cause of severe or recurrent colonic ischemia.…”

“…Antiplatelet agents have not been evaluated in treating ischemic colitis and are generally not used. As mentioned earlier, anticoagulation has been used in patients who have been proven to have hypercoagulable conditions, 28,29 but its benefit is not yet proven. Currently, if the coagulation profile is abnormal, anticoagulation should be used only in cases of recurrent colonic ischemia or in young patients with severe cases in the absence of a clear cause.…”