Answer

From question on page 161

Although anticoagulation for cerebral sinus thrombosis remains controversial, a recent Cochrane review concluded that anticoagulation was safe and associated with a potentially important reduction in the risk of death or dependency. In this case, following discussion with neurologists, she was anticoagulated for a four month period. Her vision slowly improved but did not return to normal. No prothrombotic state other than her inflammatory bowel disease (IBD) and her being on the pill could be identified. The pill was stopped and she was counselled on different methods of contraception.

In IBD, histological and haematological studies suggest that a hypercoaguable state is involved in the pathogenesis of venous thrombosis. The exact mechanism is unknown but is bound to be multifactorial. During acute flare up there are increases in factor VIII, fibrinogen, platelets, and factor V, and a decrease in antithrombin III, all of which may contribute. Thrombosis in IBD is important because it occurs in young patients, often in unusual sites such as cerebral venous sinuses, and is associated with significant morbidity and mortality. The majority of patients in a flare up will be in a hypercoaguable state and therefore young patients should be treated aggressively with rehydration therapy, prophylactic heparin, as well as conventional treatment for their IBD to try and minimise the risk of thrombosis.