P0408 - Crohn’s Disease-Associated Hypercoagulability Presenting as Massive Pulmonary Embolism and Clot in Transit: A Case of Cardiac Arrest and Survival

FNU Payal, MD¹, Karan J.. Yagnik, MD¹, Fnu Kanwal, MD², Sunny Kumar, MD³, Rahul Adwani, MD⁴, Fnu Veena, MD⁵, Shazia Shah, MD⁶
1Monmouth Medical Center, Robert Wood Johnson Medical School of Rutgers University, Long Branch, NJ; 2Elmurst hospital centre, New York, NY; 3Wright Center for Graduate Medical Education, Scranton, PA; 4UT HEALTH PEADS, Houston, TX; 5Bronx Care, New York, NY; 6Monmouth Medical Center, Long Branch, NJ

Introduction: Crohn’s disease, a chronic inflammatory bowel disorder, is increasingly recognized as a systemic disease with thromboembolic risk. Venous thromboembolism (VTE) occurs in up to 3 times more frequently in patients with inflammatory bowel disease (IBD), especially during active flares. Clot in transit is a rare and life-threatening finding often preceding massive pulmonary embolism (PE), and early recognition is critical.

Case Description/

Methods: A 42-year-old female with asthma, ADHD, and Crohn’s disease presented with worsening dyspnea and fatigue for two weeks following a flu-like illness. She was using nebulizers more frequently and reported needing assistance with basic tasks due to breathlessness. In the emergency department, she was tachypneic, hypoxic, and cyanotic. Despite BiPAP support, she progressed to respiratory failure and was intubated. Bedside echocardiogram revealed a mobile clot in transit near the tricuspid valve. A stat CTA chest confirmed a massive bilateral PE.

While being stabilized in the ICU, the patient went into cardiac arrest with pulseless electrical activity (PEA). Advanced Cardiac Life Support (ACLS) protocol was initiated, and return of spontaneous circulation (ROSC) was achieved after three rounds of epinephrine. Full-dose tenecteplase was administered during the code. The patient underwent emergent suction thrombectomy. Hypercoagulable workup including antiphospholipid antibody panel was negative. Her recent Crohn’s symptoms and elevated inflammatory markers suggested an active flare as the likely trigger of the hypercoagulable state. She recovered and was discharged on apixaban.

Discussion: Discussion

This case highlights a rare, fulminant presentation of Crohn’s disease-associated hypercoagulability leading to massive PE with clot in transit and cardiac arrest. The absence of traditional hypercoagulable conditions, recent infection, and her Crohn’s history point toward inflammation-induced thrombosis. Inflammatory bowel disease promotes thrombogenesis via endothelial activation, elevated cytokines (TNF-α, IL-6), platelet hyperactivity, and impaired fibrinolysis. Clinicians must maintain vigilance for PE in IBD patients with unexplained respiratory symptoms, even in outpatient settings. Early diagnosis and aggressive intervention, including thrombolytics and thrombectomy, can be lifesaving.

Disclosures:
FNU Payal indicated no relevant financial relationships.
Karan Yagnik indicated no relevant financial relationships.
Fnu Kanwal indicated no relevant financial relationships.
Sunny Kumar indicated no relevant financial relationships.
Rahul Adwani indicated no relevant financial relationships.
Fnu Veena indicated no relevant financial relationships.
Shazia Shah indicated no relevant financial relationships.

FNU Payal, MD¹, Karan J.. Yagnik, MD¹, Fnu Kanwal, MD², Sunny Kumar, MD³, Rahul Adwani, MD⁴, Fnu Veena, MD⁵, Shazia Shah, MD⁶. P0408 - Crohn’s Disease-Associated Hypercoagulability Presenting as Massive Pulmonary Embolism and Clot in Transit: A Case of Cardiac Arrest and Survival, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.