Advances in Pediatric Gastroenterology & GI Surgery

Venous thromboembolism (VTE) is a common and often serious complication of inflammatory bowel disease (IBD) that can affect multiple organ systems and, in some cases, can lead to death. Patients with either Crohn’s disease or ulcerative colitis are at an increased risk of VTE, especially when experiencing a disease flare. Studies have shown that adult patients with IBD have higher rates of VTE while hospitalized than patients without IBD, and as such, a number of gastroenterological societies have published VTE guidelines that encourage the consideration and/or use of mechanical or pharmacologic prophylaxis in hospitalized patients with IBD.

Dr. Kimberley Chien

Dr. Nicole Kucine

While children with IBD have a lower risk of VTE than adults, they do have an increased risk of developing it compared to children who do not have IBD when hospitalized – ranging from 0.007 percent to 1.9 percent. Some major pediatric IBD centers have instituted risk stratifications and prophylactic protocols. At NewYork-Presbyterian Komansky Children’s Hospital, pediatric gastroenterologist Kimberley Chien, MD, and her colleagues in the Division of Pediatric Gastroenterology, often use anticoagulant prophylaxis for hospitalized patients with severe IBD flares and colitic involvement.

According to Dr. Chien, studies have shown that while pediatric gastroenterologists are aware of the increased risk of VTE in their patients with IBD who are hospitalized, few provide anticoagulant prophylaxis. Their reluctance, in part, relates to a concern for the risk of increased bleeding.

Due to the range of perspectives on this issue, fear of toxicity, and a paucity of evidence from prospective multicenter trials, the pediatric gastroenterology community has not reached consensus regarding the use of VTE prophylaxis in pediatric patients with IBD. To better understand the medical impact of thrombosis in this population, as well as the financial ramifications, Dr. Chien and Nicole Kucine, MD, MS, a pediatric hematologist at NewYork-Presbyterian Komansky Children’s Hospital, recently published results of their study comparing hospitalized children with IBD who did or did not develop a VTE. Drawing on the Pediatric Health Information System inpatient database of clinical and resource utilization data for more than 45 children’s hospitals, the researchers conducted a multicenter retrospective observational study of inpatient admissions for children with IBD from 2009 to 2017.

The Weill Cornell Medicine researchers’ data clearly established that having a VTE is associated with worsened health and financial burdens in hospitalized children with inflammatory bowel disease.

Their findings, which were published in the May 1, 2021, issue of the Journal of Pediatric Gastroenterology and Nutrition, showed that in hospitalized children with IBD, VTE was associated with:

• longer median hospital stays – 11 versus 5 days
• a need for intensive care unit admission – 30.2 percent versus 4.8 percent
• in-hospital death – 1.5 percent versus 0.2 percent
• higher median adjusted costs – $32.8k versus $12.3k
• higher hospital charges – $96.6k versus $36k

Dr. Chien and Dr. Kucine noted that their data clearly established that having a VTE is associated with worsened health and financial burdens in hospitalized children with IBD. As preventing VTE in hospitalized pediatric patients is an important goal, the physicians agree that patients with IBD should be a focus of further study. “There is insufficient data regarding both safety and effectiveness of anticoagulant prophylaxis in the pediatric population,” stated the authors. “Prospective, multicenter studies focused on anticoagulant prophylaxis in hospitalized children with IBD, as well as assessment of the effects of prophylaxis on these unwanted health and financial outcomes, are essential for future development of standardized guidelines toward decreasing the unnecessary burdens associated with VTE development.”