Multifaceted challenges of deep venous thrombosis in the setting tetraplegia and ulcerative colitis: case report

Spinal Cord Series and Cases, 2025 · DOI: 10.1038/s41394-025-00703-3 · Published: March 14, 2025

Spinal Cord Injury Cardiovascular Science Gastroenterology

Simple Explanation

The case report underscores the potentially additive prothrombotic effects of ulcerative colitis and tetraplegia. Both UC and traumatic SCI increase have risk of thrombosis. UC exacerbations and bleeding pose challenges in the treatment of DVT. SCI bowel program required careful adjustments in the setting of an UC exacerbation, likely triggered by clostridium difﬁcile infection.

Study Duration

Not specified

Participants

1 male patient

Evidence Level

Level 4: Case Report

Key Findings

1
A 53-year-old male with UC and traumatic tetraplegia developed a below the knee DVT during inpatient rehabilitation, despite DVT prophylaxis.
2
Discontinuation of anticoagulation due to bleeding risk led to a signiﬁcant progression of the DVT to the bilateral lower extremities.
3
The patient developed clostridium difﬁcile infection, further exacerbating his ulcerative colitis and impacting his bowel program.

Research Summary

This case highlights the challenges in managing DVT in post-surgical patients, speciﬁcally in patients with tetraplegia and bleeding risks. The management of patients with concurrent IBD and acute traumatic injuries requires a multifaceted approach that addresses both the immediate trauma-related concerns and the chronic inﬂammatory condition. Careful consideration of VTE prophylaxis, bowel management, and infection control is crucial for optimizing patient outcomes in these complex cases.

Practical Implications

VTE Prophylaxis Post-Discharge

Patients with IBD, such as UC, may benefit from VTE prophylaxis post-discharge from hospitalization to mitigate the risk of thrombotic events.

Multifaceted Management Approach

Managing patients with concurrent IBD and acute traumatic injuries requires addressing both trauma-related concerns and the chronic inflammatory condition.

Early Treatment and Surveillance

Early treatment and increased surveillance are favored given the compounded risks of recent SCI, acute DVT, and UC with its prothrombotic effects.

Study Limitations

1
Single case report limits generalizability.
2
D-dimer testing was not performed, which could have provided additional information.
3
The pathogenesis of UC hypercoagulability is poorly understood.

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