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Venous Thromboembolic Complications in Pediatric Gastrointestinal Diseases: Inflammatory Bowel Disease and Intestinal
Renz C W Klomberg1, Lotte E Vlug1, Barbara A E de Koning1
1Division of Gastroenterology, Department of Pediatrics, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, Netherlands.
Insights
Children with gastrointestinal disorders like inflammatory bowel disease (IBD) and intestinal failure (IF) face a higher risk of venous thromboembolism (VTE). This review summarizes current VTE management strategies for these pediatric patients.
Area of Science:
- Pediatric Gastroenterology
- Hematology
- Clinical Review
Background:
- Children with inflammatory bowel disease (IBD) and intestinal failure (IF) have an elevated risk of venous thromboembolism (VTE).
- VTE complications include pulmonary embolism, sepsis, stroke, and post-thrombotic syndrome.
- Current VTE management in pediatric gastroenterology lacks standardized guidelines.
Purpose of the Study:
- To review and synthesize current knowledge on VTE management in pediatric IBD and IF.
- To highlight recent advancements in the field.
- To provide recommendations for VTE screening, prevention, and treatment.
Main Methods:
- Literature review of VTE incidence, risk factors, and management in pediatric gastroenterology.
- Focus on patients with IBD and IF.
- Discussion of anticoagulant therapies and prophylactic strategies.
Main Results:
- VTE incidence is higher in children with IF (750/10,000 patient-years) compared to IBD (4-30/10,000 patient-years).
- Key risk factors include inflammation, central venous catheters, thrombophilia, immobility, surgery, and hospitalization.
- Low molecular weight heparins and vitamin K antagonists are current treatments; direct oral anticoagulants are unstudied in this population.
Conclusions:
- Pediatric gastroenterologists face challenges in VTE management due to limited evidence and consensus.
- There is a need for evidence-based tools and recommendations for VTE prevention and treatment in pediatric IBD and IF.
- Further research on anticoagulation strategies, including direct oral anticoagulants, is warranted.
Abstract:
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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