J Pediatr Gastroenterol Nutr. 2021 Nov 1;73(5):604-609. doi:10.1097/MPG.0000000000003231.

Eden Story ^1 2, Vid Bijelic ³, Chelsea Penney ², Eric I Benchimol ^2 3 4, Jacqueline Halton ^1 2 3, David R Mack ^2 3 4

Author information

¹Division of Hematology/Oncology, Children's Hospital of Eastern Ontario.

²Faculty of Medicine, University of Ottawa.

³CHEO Research Institute.

⁴CHEO Inflammatory Bowel Disease Centre, Children's Hospital of Eastern Ontario, Ottawa, ON.

Abstract

Objectives: To evaluate for increased rectal bleeding following enoxaparin thromboprophylaxis in children hospitalized for ulcerative colitis (UC).

Methods: Retrospective cohort study (2007--2016) of 218 inpatients with active UC. Patients receiving enoxaparin were compared with a nonenoxaparin-treated patient group. Severity of UC was determined using the Pediatric Ulcerative Colitis Activity Index (PUCAI). Hemoglobin (Hb) values and packed red blood cell (pRBC) transfusions were reviewed for a 7-day period following hospital admission. A linear mixed effect model was used to compare change in Hb values between the groups. Risk of pRBC transfusion was compared using a log-rank test and Cox proportional hazard regression. A sub-analysis was also conducted restricting to patients with severe UC to provide more generalizable insight into safety profile of enoxaparin.

Results: Children hospitalized for UC and receiving enoxaparin were more likely to have severe disease, received infliximab therapy and be admitted after 2010. Use of enoxaparin showed there was not a difference (P = 0.60) in the fall of Hb detected among those with acute severe colitis (initial PUCAI ≥65) during the week following admission. Moreover, there was no difference in the risk of requiring a pRBC transfusion with enoxaparin use (log-rank test all patients: P = 0.80; severe UC: P = 0.88; Cox proportional hazard regression all patients: P = 0.72; severe UC: 0.85).

Conclusions: There was no difference in Hb levels or need for blood transfusions in children hospitalized for severe UC (PUCAI ≥65) whether or not they received enoxaparin for thromboembolism prophylaxis.