Risk Factors for Venous Thromboembolism in Children and Young Adults With Inflammatory Bowel Disease

McKie, Kerri; McLoughlin, Robert J.; Hirsh, Michael; Cleary, Muriel A.; Aidlen, Jeremy T.

doi:10.1016/j.jss.2019.04.087

Cited by 19 publications

(19 citation statements)

References 19 publications

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“…For instance, while some studies had reported a significantly increased risk in aging inflammatory bowel disease patients ( 24 , 27 , 30 ), other studies did not report this outcome ( 28 , 31 , 32 ). Similarly, there is still a lack of consensus regarding the risks of venous thromboembolism associated with steroid therapy, surgery, obesity in patients with inflammatory bowel disease ( 24 , 28 , 29 , 33 – 35 ). To the best of our knowledge, there are no systematic reviews or meta-analyses that summarized the existing data, evaluating risk factors that can influence the incidence of venous thromboembolism in patients with inflammatory bowel disease.…”

Section: Introductionmentioning

confidence: 99%

Risk Factors of Venous Thromboembolism in Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis

Zhang

Wang

2021

Front. Med.

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Background: Patients suffering from chronic inflammatory disorders, such as inflammatory bowel disorder, are at higher risk of developing thromboembolism. The chronic inflammatory nature of inflammatory bowel disease has been identified as a predominant reason for a state of Virchow's triad (i.e., endothelial dysfunction, stasis, and general hypercoagulability), eventually leading to the onset of venous thromboembolism. Recent studies show that certain factors, such as demographics, medication history, and history of surgical intervention may increase thromboembolism risk in patients with inflammatory bowel disease. However, to date, no study has attempted to evaluate the effect of different risk factors associated with the development of venous thromboembolism in inflammatory bowel disease patients.Objective: To evaluate the risk factors that can influence the incidence of venous thromboembolism in patients with inflammatory bowel disease.Methods: Academic literature was systematically searched based on the PRISMA guidelines across five databases: Web of Science, EMBASE, CENTRAL, Scopus, and MEDLINE. A random-effect meta-analysis was conducted to evaluate the hazard ratio for the risk factors (i.e., aging, gender, steroid therapy, surgery, and ulcerative colitis) that can influence the incidence of venous thromboembolism in patients with inflammatory bowel disease.Results: From a total of 963 studies, 18 eligible studies with 1,062,985 (44.59 ± 10.18 years) patients suffering from inflammatory bowel disease were included in the review. A meta-analysis revealed a higher risk of aging (Hazard's ratio: 2.19), steroids (1.87), surgery (1.48), and ulcerative colitis (2.06) on venous thromboembolism in patients with inflammatory bowel disease. We also found that the female gender (0.92) did not increase the incidence of venous thromboembolism in inflammatory bowel disease patients.Conclusion: The study provides preliminary evidence regarding high risks associated with ulcerative colitis, steroid consumption, and aging for the development of venous thromboembolism in patients with inflammatory bowel disease. The findings from this study may contribute to developing awareness among clinicians, better risk stratification and prevention of venous thromboembolic complications in patients with inflammatory bowel disease.

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Section: Introductionmentioning

confidence: 99%

Risk Factors of Venous Thromboembolism in Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis

Zhang

Wang

2021

Front. Med.

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“…Inflammatory bowel disease is a known risk factor for VTE, with prior literature identifying a prevalence ratio of 1.8 in pediatric patients with IBD compared to other hospitalized children [9]. Further, children with IBD who undergo intra-abdominal operations are at even greater risk of thrombotic events [3,4]. Studies in adult patients have found that active disease flares increase the risk of VTE in IBD patients as well [1,2].…”

Section: Discussionmentioning

confidence: 99%

“…Introduction Inflammatory bowel disease (IBD) is a known risk factor for venous thromboembolism (VTE) in adults, and national guidelines exist that direct chemoprophylaxis in this population [1,2]. Pediatric patients with IBD have also been shown to have increased incidence of VTE (deep venous thrombosis, DVT or pulmonary embolism, PE), though the data is less robust [3,4]. A recent review of the Kids' Inpatient Database demonstrated a 1% incidence of DVT in pediatric patients hospitalized with IBD, and the odds were twice as high for patients undergoing a major surgical procedure [4].…”

mentioning

confidence: 99%

“…Pediatric patients with IBD have also been shown to have increased incidence of VTE (deep venous thrombosis, DVT or pulmonary embolism, PE), though the data is less robust [3,4]. A recent review of the Kids' Inpatient Database demonstrated a 1% incidence of DVT in pediatric patients hospitalized with IBD, and the odds were twice as high for patients undergoing a major surgical procedure [4]. Similarly, in adult patients with IBD the risk of developing a VTE is as high as 2-3% following abdominal surgery.…”

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confidence: 99%

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The incidence of venous thromboembolism in children following colorectal resection for inflammatory bowel disease: A multi-center study

Bence

Traynor

Polites

et al. 2020

Journal of Pediatric Surgery

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Background/PurposeChildren with inflammatory bowel disease (IBD) have increased risk for venous thromboembolism (VTE). We sought to determine incidence and risk factors for postoperative VTE in a multicenter cohort of pediatric patients undergoing colorectal resection for IBD. Methods Retrospective review of children ≤18yrs who underwent colorectal resection for IBD from 2010-2016 was performed at four children's hospitals. Primary outcome was VTE that occurred between surgery and last follow-up. Factors associated with VTE were determined using univariable and multivariable analyses. ResultsTwo-hundred-and-seventy-six patients were included with median age 15yrs [13,17]. Forty-two children (15%) received perioperative VTE chemoprophylaxis, and 88 (32%) received mechanical prophylaxis. DVT occurred in 12 patients (4.3%) at a median of 14 days postoperatively [8,147]. Most were portomesenteric (n=9, 75%) with the remaining catheter-associated DVTs in extremities (n=3, 25%). There was no association with chemoprophylaxis (p>0.99). On Cox regression, emergent procedure [HR 18.8,[95][96][97][98][99][100][101][102][103][104][105][106][107][108][109][110][111], perioperative plasma transfusion [HR 25.1,, and postoperative infectious complication [HR 10.5,] remained predictive of DVT. ConclusionLess than 5% of pediatric IBD patients developed postoperative VTE. Chemoprophylaxis was not protective but rarely used. Patients with risk factors identified in this study should be monitored or given prophylaxis for VTE.

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“…Although pediatric gastroenterologists are aware of the potentially increased risk of VTE in children with IBD, VTE prophylaxis is being provided by only about 1/3 of physicians. The main reason cited for not providing prophylaxis is lack of published literature, which emphasizes the need for collaborative clinical trials and guideline development [64].…”

Section: Pediatric Datamentioning

confidence: 99%

The risk of cardiovascular complications in inflammatory bowel disease

et al. 2020

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Inflammatory bowel disease (IBD) is a chronic, relapsing disease of unknown etiology involving gastrointestinal tract. IBD comprises two main entities: ulcerative colitis and Crohn’s disease. Several studies showed increased risk of cardiovascular complications in chronic inflammatory disorders, especially during IBD relapses. Endothelium plays a role in physiologic regulation of vascular tone, cell adhesion, migration and resistance to thrombosis. Also, its dysfunction is associated with increased risk of atherosclerosis development. There are several potential links between chronic IBD-related inflammatory processes and the risk of cardiovascular disease, but insight into pathogenetic pathways remains unclear. We present the current concepts and review of adult and pediatric studies on the risk of CVD in IBD.

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Risk Factors for Venous Thromboembolism in Children and Young Adults With Inflammatory Bowel Disease

Cited by 19 publications

References 19 publications

Risk Factors of Venous Thromboembolism in Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis

Risk Factors of Venous Thromboembolism in Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis

The incidence of venous thromboembolism in children following colorectal resection for inflammatory bowel disease: A multi-center study

The risk of cardiovascular complications in inflammatory bowel disease

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