Upadacitinib in refractory ulcerative colitis patients with high thromboembolic risk: two case reports.

Two refractory UC patients with high thromboembolic risk were successfully treated with upadacitinib combined with rivaroxaban.

• Both patients presented with increased stool frequency, decreased stool consistency, abdominal pain, and hematochezia.
• Both patients had previously failed mesalazine, corticosteroids, vedolizumab, and infliximab without achieving clinical remission.
• Treatment was initiated after multidisciplinary conference and thorough informed consent.
• Two months after treatment initiation, both patients showed significant improvement in symptoms and endoscopic findings.

The male patient had a history of deep vein thrombosis (DVT) in his left lower limb, representing high thromboembolic risk.

• This patient had prior DVT in the left lower limb.
• Upadacitinib and rivaroxaban were used concurrently as the treatment strategy.
• No thromboembolic events or other adverse effects were observed following treatment initiation.

The female patient had thrombophlebitis in a branch of the cephalic vein on the left forearm, representing high thromboembolic risk.

• This patient had thrombophlebitis in a branch of the cephalic vein on the left forearm.
• Upadacitinib and rivaroxaban were used concurrently as the treatment strategy.
• No thromboembolic events or other adverse effects were observed following treatment initiation.

No thromboembolic events or other adverse effects were observed in either patient following concurrent upadacitinib and rivaroxaban treatment.

• Observation period extended at least two months after treatment initiation.
• Upadacitinib is a novel selective JAK inhibitor approved for adults with UC, for which caution is advised in patients with increased thrombosis risk.
• The concurrent anticoagulation strategy with rivaroxaban appeared to mitigate thromboembolic risk in both cases.