VTE in kids with IBD

VTE in kids with IBD

January 20, 2025

Issue 02

Clinical Question

What is the risk of venous thromboembolism in children with IBD?

Editor’s Bottom Line

Active IBD is associated with a significantly increased risk of venous thromboembolism in children. Health care providers managing pediatric IBD should consider strategies for prevention and early detection.

Reference

Harvey PR, McNulty D, Coupland B, et al. The Risk of Venous Thromboembolism in Children With Inflammatory Bowel Disease. Inflamm Bowel Disease. Epub ahead of print Nov 14, 2024; https://academic.oup.com/ibdjournal

Synopsis

To determine the risk of venous thromboembolism (VTE) in children with IBD, researchers in England analyzed data from 2001–2019 from a national administrative database called Hospital Episode Statistics (HES). They compared three cohorts of patients: those with IBD alone, those with VTE alone and those with IBD who had VTE diagnosed no more than six months prior to their IBD diagnosis. They chose this window considering the hypothesis that active inflammation is the greatest risk factor for VTE in IBD patients.

To calculate the relative risk of VTE in children with IBD, the authors also included a comparator age-matched English cohort without IBD.

The researchers identified 85 children with VTE diagnosed within six months prior to an IBD diagnosis and 4,160 with VTE alone in the HES. Statistical analysis found an absolute risk of VTE in children with IBD of 9.42 per 10,000 patient-years (95% Confidence Interval [CI], 7.4–11.4), compared to a risk of 0.18 per 10,000 patient years in children without IBD (95% CI, 18–0.19). The risk of VTE in the IBD population was highest during the six months prior to, and the one year after, an IBD diagnosis (18/10,000 patient-years; 95% CI, 13.7–22.4).

Compared to children without IBD, the relative risk for VTE among those with IBD was highest for those 0 to 8 years of age (Relative Risk: 96.5; 95% CI, 51.8–179.9) and those 9 to 11 years of age (RR: 153.1; 95% CI, 81.2–288.8). In contrast, those 13 to 17 years of age had a lower relative risk of developing a VTE (RR: 14.3; 95% CI, 10.3–20.0).

Parsing VTE data in the IBD population according to event subtype, 58.8% had a deep vein thrombosis (DVT), 23.5% had a pulmonary embolism (PE) and 17.6% had a cerebral venous sinus thrombosis (CVST). In contrast, the corresponding numbers among the general pediatric VTE cohort were 67.8% for DVT, 28% for PE and only 4.2% for CVST (p=0.001).

Subgroups of IBD patients with the higher rates of VTE included those with ulcerative colitis, females, members of minority ethnic groups and those with higher Charlson comorbidity index scores.

Details

Study Design: Nationwide retrospective database analysis
Funding: None
Allocation: Not applicable
Setting: Multicenter
Level of Evidence: 2b