Abstract: Inflammatory bowel disease (IBD) involves chronic intestinal inflammation driven by gut-brain axis imbalance, fostering complications through an “inflammation-neuro-coagulation” triad. Current staging systems inadequately capture the dynamics of this multidimensional network. Therefore, integrated multi-omics analyses—including metagenomics, metabolomics, and single-cell transcriptomics—are essential to construct dynamic models that monitor coagulation, microbiome, and metabolism for precise assessment of disease activity and thrombotic or bleeding risks. Interventions targeting gut-brain axis nodes, such as eliminating tissue factor-positive (TF⁺) T cells or modulating vagal activity, show potential to disrupt the inflammation-coagulation cycle, although rigorous randomized trials are still needed. Artificial intelligence (AI)-assisted systems that integrate real-time biomarker monitoring with multi-omics predictions represent a novel paradigm for managing IBD-related coagulation dysfunction. Key challenges include elucidating gut-brain-liver axis regulation of coagulation and characterizing platelet functional heterogeneity. Future efforts must prioritize ethically compliant multi-omics platforms and racially stratified risk models to advance personalized coagulation management in IBD. Plain Language Summary: 1. Inflammatory bowel disease (IBD) is closely linked to gut-brain axis imbalance, which drives intestinal and extra-intestinal complications through an “inflammation-neuro-coagulation” triad. 2. Multi-omics technologies are needed to construct dynamic monitoring models of coagulation-microbiome-metabolism for precise identification of disease activity and thrombus/bleeding risks. 3. Intervention strategies targeting key nodes of the gut-brain axis have made progress, such as eliminating tissue factor-positive (TF⁺) T cells or regulating vagus nerve activity, which shows promise in breaking the inflammation-coagulation vicious cycle. 4. Developing AI-assisted personalized anticoagulation decision systems, combined with real-time biomarker monitoring and multi-omics prediction models, provides a new paradigm for precise management of IBD complications. 5. Future research should focus on deciphering the regulatory network of the gut-brain-liver axis on coagulation balance and revealing the dynamic evolution of platelet heterogeneity in extra-intestinal thrombus formation in IBD. Keywords: inflammatory bowel disease, gut microbiota, thromboembolism, platelet dysfunction, multi-omics integration
Lu et al. (Sun,) studied this question.