A128 ATYPICAL VENOUS THROMBOEMBOLISM IN INFLAMMATORY BOWEL DISEASE: A CASE SERIES OF 2 LIFE-THREATENING PRESENTATIONS
Bibliographic record
Abstract
Patients with inflammatory bowel disease (IBD) carry a 2–4 fold higher risk of venous thromboembolism (VTE) than persons in the general population. Most VTE present as deep vein thrombosis (DVT) of the lower extremity or as pulmonary emboli (PE), but they can also occur in other locations, including mesenteric and cerebral sinus thrombosis. Such atypical VTE may evade detection until the development of serious complications. We describe 2 unusual presentations of VTE associated with serious sequalae at our centre and review the literature of VTE in IBD. We retrospectively reviewed 2 atypical cases of VTE in IBD patients admitted to The Ottawa Hospital in June 2018. We also conducted a Pubmed search to review the literature regarding the incidence and varied manifestations of VTE in persons with IBD. A 21-year old male with a history of ulcerative colitis presented with typical symptoms of a colitis flare with pain and diarrhea along with severe unremitting abdominal pain. A flexible sigmoidoscopy showed severe ulcerative colitis and an area of ischemic colitis in the sigmoid colon. Symptoms did not improve with IV steroids and a CT scan was done showing extensive abdominal mesenteric venous thrombosis that was treated with systemic anticoagulation and close monitoring. A 58-year old female with a history of ALS and colitis, was found to have severe ulcerative colitis on endoscopy. She developed a severe headache followed by unilateral parasthesias and weakness and found to have a cerebral sinus venous thrombosis. This was complicated by a parietal lobe haemorrhagic infarction and death. IBD in itself is a risk factor for VTE, but the risk increases further with active disease, hospitalization, steroid use and surgery. The use of immunomodulators and biologic agents has been found to decrease the risk of VTE. Mesenteric and cerebral venous thrombosis make up <10% of VTE complications in IBD. While VTE in IBD patients is not rare, atypical presentations, such as mesenteric and cerebral sinus thrombosis, are less common and may evade diagnosis until the development of serious sequelae. Clinicians should be vigilant about recognizing the varied presentations of VTE in the IBD population. All IBD patients admitted to hospital should receive VTE prophylaxis, as per current guidelines. None
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.004 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.003 | 0.002 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".