1217 - Multifaceted Challenges: A Case Report of Deep Venous Thrombosis in the setting of Tetraplegia and Ulcerative Colitis

Case Diagnosis: Traumatic spinal cord injury (SCI) tetraplegics are at an increased risk of deep venous thrombosis (DVT) due to immobility and altered hemostasis. Inflammatory bowel diseases such as ulcerative colitis (UC) face an elevated risk of thrombotic events due to chronic inflammation, in addition to the risk of diarrhea and bleeding. In this case, the patient presents with both tetraplegia and UC.

Case Description: A 53 year old male with ulcerative colitis and traumatic R C3 L C4 sensory, R C3 L C5 motor ASIA impairment C tetraplegia, developed a below the knee DVT during inpatient rehabilitation, despite DVT prophylaxis. Due to potential risk of progression, the patient received an IVC filter and was initiated on full anticoagulation. However, due to bleeding complications, anticoagulation was discontinued, followed by worsening of DVT to the bilateral lower extremities which advanced above the knees. Subsequently, the patient developed clostridium difficile infection, further exacerbating his ulcerative colitis. Bowel program was impacted and treatment was provided for both clostridium difficile and ulcerative colitis.

Discussions: There are unique challenges in both preventing and managing thrombotic events in patients with both UC and traumatic SCI; both conditions increase the risk of thrombosis. UC exacerbations and bleeding challenge the treatment of DVT. The need to discontinue anticoagulation due to bleeding risk led to a significant progression of DVT. SCI bowel program required careful adjustments in the setting of an UC exacerbation likely triggered by clostridium difficile infection.

Conclusions: This is the first case report that underscores the importance of recognizing the potentially additive prothrombotic effects of ulcerative colitis and tetraplegia. It highlights the intricate interplay between tetraplegia and ulcerative colitis in the management of DVT, as well as SCI bowel program adjustments. This complex case conveys the optimal approach to anticoagulation must be carefully weighed against the risk of bleeding.