The Incidence and Characteristics of Venous Thromboembolisms in Paediatric-Onset Inflammatory Bowel Disease; a Prospective International Cohort Study Based on the PIBD-SETQuality Safety Registry

Aardoom, M; Klomberg, R; Kemos, Polychronis; Ruemmele, Frank M; Group, The PIBD-VTE; Ommen, Heleen van; Ridder, Lissy de; Croft, Nicholas M.

doi:10.2139/ssrn.3844854

Cited by 6 publications

(21 citation statements)

References 46 publications

(59 reference statements)

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“…In a recent meta-analysis, VTE incidence in the general pediatric population was found to be 0.27 per 10,000 person-years (PY) ( 16 ).…”

Section: Incidencementioning

confidence: 99%

“…Another Danish population-based study found an incidence rate of 8.9 per 10,000 PY for VTE in children with IBD, with a hazard ratio of 6.6 compared to age-matched controls. The prospective international Safety Registry, covering 24,802 children with IBD, reported an incidence of 3.09 per 10,000 PY, 14-fold higher than the incidence rate in the general pediatric population ( 16 ). Altogether, these studies clearly show an increased VTE risk in children with IBD, though with varying incidence rates, which is likely the result of a different methodology and background population of the studies.…”

Section: Incidencementioning

confidence: 99%

“…Interestingly, CSVT has been described as a relatively common VTE type in children with IBD. According to two studies, including a systematic review, CSVTs made up to almost 50% of VTE cases, with a reported incidence rate of 1.86 per 10,000 PY in the Safety Registry ( 16 , 18 ). Another single-center retrospective study found that in 4/154 (2.6%) newly-diagnosed children with IBD a CSVT occurred within 5 years.…”

Section: Incidencementioning

confidence: 99%

“…One study reported an incidence of 117.9 per 10,000 PY in hospitalized children with IBD ( 28 ). The Safety Registry study reported a relative risk of 559 for hospitalization ( 16 ). However, VTE development is not limited to hospitalized patients.…”

Section: Pathophysiologymentioning

confidence: 99%

“…However, VTE development is not limited to hospitalized patients. According to a recently published study, VTE was the indication for admission in 11/23 (48%) cases ( 29 ), and in the Safety Registry study, 9/21 (43%) cases occurred in non-hospitalized patients ( 16 ). Therefore, awareness of VTE occurrence and prevention should not be limited to admitted patients.…”

Section: Pathophysiologymentioning

confidence: 99%

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Venous Thromboembolic Complications in Pediatric Gastrointestinal Diseases: Inflammatory Bowel Disease and Intestinal Failure

et al. 2022

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In children with gastrointestinal disorders such as inflammatory bowel disease (IBD) and intestinal failure (IF), the risk of venous thromboembolism (VTE) is increased. VTE may lead to pulmonary embolism, sepsis and central line infection, stroke and post-thrombotic syndrome. The purpose of this review is to summarize current knowledge and recent advances around VTE management in pediatric gastroenterology with a focus on IBD and IF. The VTE incidence in children with IBD is reported to be around 4–30 per 10,000 patient-years, with higher incidences for hospitalized children. While in general, IF is less common than IBD, the VTE incidence in children with IF is around 750 per 10,000 patient-years. The most common risk factors for development of VTE involve deviations leading to Virchow's triad (endothelial damage, stasis, and hypercoagulability) and include active inflammation, particularly with colonic involvement, presence of a central venous catheter, underlying thrombophilia, reduced mobility, surgery, and hospitalization. Classes of anticoagulants used for treatment of VTE are low molecular weight heparins and vitamin K antagonists. However, the use of direct oral anticoagulants for treatment or prevention of VTE has not been studied in this pediatric population yet. Pediatric gastroenterologists apply different VTE prevention and treatment strategies due to lack of literature and lack of consensus. We discuss the role of primary and secondary prophylactic use of anticoagulants, and provide tools and recommendations for screening, prevention and management for the specific pediatric populations.

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“…In a recent meta-analysis, VTE incidence in the general pediatric population was found to be 0.27 per 10,000 person-years (PY) ( 16 ).…”

Section: Incidencementioning

confidence: 99%

Section: Incidencementioning

confidence: 99%

Section: Incidencementioning

confidence: 99%

Section: Pathophysiologymentioning

confidence: 99%

Section: Pathophysiologymentioning

confidence: 99%

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Venous Thromboembolic Complications in Pediatric Gastrointestinal Diseases: Inflammatory Bowel Disease and Intestinal Failure

et al. 2022

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Management of Anastomotic Leaks in Ileal Pouch Anal Anastomosis for Ulcerative Colitis

Huang

Plietz

Greenstein

et al. 2022

Clin Colon Rectal Surg

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Anastomotic leaks remain a dreaded complication after ileal pouch anal anastomosis (IPAA). Their impacts can be devastating, ranging from an acute leak leading to postoperative sepsis to chronic leaks and sinus tracts resulting in long-term pouch dysfunction and subsequent pouch failure. The management of acute leaks is intricate. Initial management is important to resolve acute sepsis, but the type of acute intervention impacts long-term pouch function. Aggressive management in the postoperative period, including the use of IV fluids, broad-spectrum antibiotics, and operative interventions may be necessary to preserve pouch structure and function. Early identification and knowledge of the most common areas of leak, such as at the IPAA anastomosis, are important for guiding management. Long-term complications, such as pouch sinuses, pouch-vaginal fistulas, and diminished IPAA function complicate the overall survival and functionality of the pouch. Knowledge and awareness of the identification and management of leaks is crucial for optimizing IPAA success.

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Venous thromboembolism in pediatric inflammatory bowel disease: an 11-year population-based nested case–control study in Canada

Ding¹,

Sherlock²,

Chan

et al. 2022

Blood Coagulation &Amp; Fibrinolysis

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To investigate the occurrence of venous thromboembolism (VTE), clinical characteristics, risk factors, treatment outcomes, and anticoagulation safety in pediatric inflammatory bowel disease (IBD) over an 11-year period. A nested case–control study within an identified cohort was performed amongst children with IBD from 2009 to 2020 in Canada. There were 890 hospitalizations during the study period, and 15 venous thromboembolic events (1.69%) among 12 patients occurred, including 12 with ulcerative colitis and three with Crohn's disease. VTE proportions were significantly different between female (2.7%) and male (0.8%) patients (P = 0.03). VTE in the ulcerative colitis group (4.2%) was significantly higher than in the Crohn's disease group (0.6%) (P = 0.001). Central venous catheter and length of hospital stay were correlated to VTE development. Twelve of 15 (80%) with VTEs presented symptoms related to extremity thrombosis and pulmonary embolism. Nine of the 15 (60%) had a deep vein thrombosis, and 2 (13.3%) developed a severe pulmonary embolism. Seven of 15 (47%) received anticoagulation therapy for 1–6 months. VTE-related symptoms and repeat imaging tests improved with no bleeding complication in those treated with anticoagulation therapy. No patients received long-term thromboprophylaxis after antithrombotic treatment was discontinued. The VTE proportion in pediatric IBD patients was relatively low. Children with VTE were disproportionately females with ulcerative colitis compared with children without VTE. Patients with VTE had a good prognosis after anticoagulation therapy without mortality or increased bleeding events. The role of VTE screening and efficacy of thromboprophylaxis need to be further evaluated.

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The Incidence and Characteristics of Venous Thromboembolisms in Paediatric-Onset Inflammatory Bowel Disease; a Prospective International Cohort Study Based on the PIBD-SETQuality Safety Registry

Abstract: the PIBD-VTE group; C.H. (Heleen) van Ommen 4 ; Lissy de Ridder* 1 ; Nicholas M. Croft* 2 ; on behalf of the PIBD-SETQuality consortium, ‡ These authors share first authorship.

Cited by 6 publications

References 46 publications

Venous Thromboembolic Complications in Pediatric Gastrointestinal Diseases: Inflammatory Bowel Disease and Intestinal Failure

Venous Thromboembolic Complications in Pediatric Gastrointestinal Diseases: Inflammatory Bowel Disease and Intestinal Failure

Management of Anastomotic Leaks in Ileal Pouch Anal Anastomosis for Ulcerative Colitis

Venous thromboembolism in pediatric inflammatory bowel disease: an 11-year population-based nested case–control study in Canada

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