A recent “Grand Rounds” review of venous thrombosis (VT) in pediatric inflammatory bowel disease (E Mitchel, T Diamond, L Albenberg. J Pediatr 2020; 216: 213-7) provides some practical advice in an area in need of more clarity.

Risk factors for VT:

• inflammation
• malnutrition
• dehydration
• malabsorption
• need for surgery
• medications (eg. steroids)
• immobilization
• infection
• placement of central line
• hormonal contraceptive use
• cigarette use
• hereditary thrombophilia/first-degree relative with VT

Key points:

• Pediatric patients with IBD are at increased risk for VT with an estimated incidence between 0.09% and 1.9%.  Patients hospitalized with an IBD flare have a “6-fold increased risk for pulmonary embolism and deep-vein thrombosis as compared” to hospitalized patients without IBD.  In another study, the risk was lower with a relative risk for VT of 2.37 for Crohn’s and 1.99 for ulcerative colitis (UC).
• ESPGHAN guidelines recommend prophylactic anticoagulation in patients with acute severe colitis and at least 1 risk factor (in prepubertal children — at least 2 risk factors).  Mobilization and hydration are also recommended.
• At the authors’ institution, “patients <12 years do not meet routine criteria” for thromboprophylaxis unless at high risk.
• Patients >12 years who are at medium or high risk are given mechanical prophylaxis with a pneumatic compression device (if no contraindications).
• In those at high risk and >12 years, pharmacologic prophylaxis is considered in concert with hematology service. “High risk is considered altered mobility and at least 1 risk factor.”

My take: In adolescents hospitalized with IBD, this article suggests that almost all should receive mechanical prophylaxis for VT and a subset at increased risk may benefit from pharmaccologic prophylaxis.

Related blog posts:

• Catheter-Related Venous Thromboembolism
• Venous Thromboembolism: A Good Question for Pediatric Collaboration
• VTE with IBD
• Neurological Complications Associated with Inflammatory Bowel Disease

From a visit to Montreal