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Venous Thromboembolism Prophylaxis in Pediatric Inflammatory Bowel Disease Patients Hospitalized With a Central Line

Laura G Hamant1, Lucia Gonzalez-Llanos1, Ashish S Patel1,2

  • 1From the Phoenix Children's Hospital, Phoenix, AZ.

Journal of Pediatric Gastroenterology and Nutrition
|February 23, 2023
PubMed

Insights

Implementing a venous thromboembolism (VTE) protocol significantly increased VTE prophylaxis in hospitalized inflammatory bowel disease (IBD) patients with central venous catheters. This led to a rise in VTE diagnosis, potentially due to improved detection and awareness.

Area of Science:

  • Gastroenterology
  • Cardiology
  • Healthcare Quality Improvement

Background:

  • Hospitalized patients with inflammatory bowel disease (IBD) face an elevated risk of venous thromboembolism (VTE).
  • Central venous catheters (CVCs) in IBD patients further compound this VTE risk.
  • Standardized VTE prophylaxis protocols are crucial for managing high-risk patient populations.

Purpose of the Study:

  • To evaluate the impact of a VTE prophylaxis protocol on VTE prophylaxis rates in IBD patients with CVCs.
  • To assess the subsequent effect of the protocol on VTE incidence within this cohort.
  • To analyze changes in diagnostic practices, such as Doppler ultrasound (US), following protocol implementation.

Main Methods:

  • Retrospective analysis of 313 hospitalizations in 187 IBD patients with central venous access from March 2013 to March 2020.
  • Data collection via ICD-10 codes, CPT codes, and chart review, comparing pre- and post-protocol implementation (March 2018).
  • Statistical comparison using independent-sample t tests and chi-squared tests to analyze prophylaxis rates, Doppler US, and VTE diagnoses.

Main Results:

  • VTE prophylaxis use surged from 5.24% to 63.10% post-protocol (P < 0.001).
  • Doppler US utilization increased from 9.17% to 17.86% (P < 0.05).
  • VTE diagnosis rates rose from 0.87% to 7.14% (P < 0.01), with no demographic changes.

Conclusions:

  • The VTE protocol successfully enhanced prophylaxis and diagnostic tool usage in IBD patients with CVCs.
  • The observed increase in VTE diagnoses may reflect improved detection and heightened clinical awareness post-protocol.
  • Protocol implementation is effective in addressing VTE risk in hospitalized IBD patients.
Abstract

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