J Crohns Colitis. 2022 Jun 24;16(5):695-707. doi: 10.1093/ecco-jcc/jjab171.

Martine A Aardoom ¹, Renz C W Klomberg ¹, Polychronis Kemos ², Frank M Ruemmele ³, PIBD-VTE Group; C H Heleen van Ommen ⁴, Lissy de Ridder ¹, Nicholas M Croft ², PIBD-SETQuality Consortium

Author information

Collaborators

Andrew Fagbemi, Fevronia Kiparissi, Joachim J Schweizer, Shaji Sebastian, Richard K Russell, Franco Torrente, Marije van Mill, Lissy de Ridder, Nicholas M Croft, Michela Tempia-Caliera, Way Seah Lee, Anna J Pigott, Martin Classen, Mary-Anne Morris, Rafeeq Muhammed, Seamus Hussey, Mara Cananzi, Timothy J Menz, Ghassan T Wahbeh, Dan Turner, Gili Focht, Nicholas Croft, Lissy de Ridder, Janneke Samsom, Gigi Veereman, Mattias Neyt, Polychronis Kemos, Sibylle Koletzko, Annecarin Brückner, Arie Levine, Richard Russell, Arie Levine, Dror Weiner, Anne Griffiths, Marina Aloi, Jeroen Raes, Annick Christiaens, Thomas Walters, Michael Walker, Frank Ruemelle, Christine Nguyen Demange, Laetitia Bigot

Affiliations

¹Department of Paediatric Gastroenterology, Erasmus Medical Centre - Sophia Children's Hospital, Rotterdam, The Netherlands.

²Paediatric Gastroenterology, Centre for Immunobiology, Blizard Institute, Barts and the London School of Medicine, Queen Mary University of London, London, UK.

³Department of Paediatric Gastroenterology, Université Paris Descartes, Sorbonne Paris Cité, APHP, Hôpital Necker Enfants Malades , Paris, France.

⁴Department of Paediatric Haematology, Erasmus Medical Centre - Sophia Children's Hospital, Rotterdam, the Netherlands.

Abstract

Background and aims: Guidelines regarding thromboprophylaxis for venous thromboembolisms [VTEs] in children with inflammatory bowel disease [IBD] are based on limited paediatric evidence. We aimed to prospectively assess the incidence of VTEs in paediatric-onset IBD [PIBD], characterize PIBD patients with a VTE and identify potential IBD-related risk factors.

Methods: From October 2016 to September 2020, paediatric gastroenterologists prospectively replied to the international Safety Registry, monthly indicating whether they had observed a VTE case in a patient <19 years with IBD. IBD details [type, Paris classification, clinical and biochemical disease activity, treatment] and VTE details [type, location, treatment, outcome] were collected. To estimate VTE incidence, participants annually reported the number of PIBD patients, data source and catchment area of their centre. A systematic literature review and meta-analysis was performed to calculate the VTE incidence in the general paediatric population.

Results: Participation of 129 PIBD centres resulted in coverage of 24 802 PIBD patients. Twenty cases of VTE were identified [30% Crohn's disease]. The incidence of VTEs was 3.72 (95% confidence interval [CI] 2.27-5.74) per 10 000 person-years, 14-fold higher than in the general paediatric population (0.27 [95% CI 0.18-0.38], p < 0.001). Cerebral sinus venous thrombosis was most frequently reported [50%]. All but one patient had active IBD, 45% were using steroids and 45% were hospitalized. No patient received thromboprophylaxis, whereas according to current PIBD guidelines, this was recommended in 4/20 patients.

Conclusion: There is an increased risk of VTEs in the PIBD population compared to the general paediatric population. Awareness of VTE occurrence and prevention should be extended to all PIBD patients with active disease, especially those hospitalized.