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Will I have to continue with medicines all my life?

Q: I am a 43 years old male. I am suffering from ulcerative colitis for the last 14 years. I was recently diagnosed with deep vein thrombosis (DVT) in my left leg. After the prolonged treatment the clots are no longer seen in the follow up colour doppler sonography. Please tell me if there are any chances of clots appearing again and will I have to continue with the medication all my life? If I choose to go for surgery then will DVT also get cured?

A:There is increased incidence of DVT and Pulmonary embolism (PE) in cases of ulcerative colitis (UC). It is possible that the attack of DVT had no relation to the pre-existing UC. There are some issues to be kept in mind regarding this combination of UC and DVT. Due diligence regarding the exploration of basic cause of the DVT has to be kept in mind. This includes other causes of DVT and PE like antiphospholipid syndrome, lupus and hyperhomocysteinemia. In case of UC one has to remember that the DVT may be an indicator of malignancy of the colon, that is transformation of UC in to colonic malignancy. This particularly true when the UC has been longstanding. If that is the case then colectomy may be mandatory. This is to be borne in mind while investigating the causes of DVT. In case the colon appears clear then one has to be guided by the behaviour of DVT, i.e. its recurrence or if there is associated PE. Should either of these appear then the anticoagulant therapy should be continued for life. There should be reduction of the risk of DVT after colonic surgery, but it is difficult to quantify the benefit as the incidence of DVT does increase with the advent of UC.

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