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Venous Thromboembolism in Pediatric Inflammatory Bowel Disease: A Scoping Review
Jermie Gandhi1, Keith Mages2, Nicole Kucine3
1From the Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Weill Cornell Medicine, New York, NY.
Insights
Pediatric inflammatory bowel disease (pIBD) patients face venous thromboembolism (VTE) risks. This review details current data on VTE prevention and management in children with pIBD, highlighting a need for clinical guidelines.
Area of Science:
- Gastroenterology
- Pediatrics
- Hematology
Background:
- Pediatric inflammatory bowel disease (pIBD) can manifest with extra-intestinal complications, including venous thromboembolism (VTE).
- Current guidelines for VTE prevention and treatment in pediatric patients with IBD are lacking.
- This scoping review addresses the existing data gap regarding VTE in pIBD.
Purpose of the Study:
- To conduct a comprehensive scoping review of the literature on venous thromboembolism (VTE) in pediatric inflammatory bowel disease (pIBD).
- To detail available data on the prevention and management strategies for VTE in this vulnerable patient population.
Main Methods:
- A systematic literature search was conducted using PRISMA extension for Scoping Reviews (PRISMA-ScR) methodology.
- Literature published between 1967 and 2023 was identified, screened, and quality-graded.
- Data from 107 studies involving 216 pediatric patients with IBD and VTE were analyzed.
Main Results:
- The median age of pediatric patients with IBD and VTE was 14 years.
- Ulcerative colitis was more common (70%), with VTE often occurring within the first year of diagnosis (52%).
- Cerebral venous sinus thrombosis was the most frequent VTE type (34%), and elevated Factor VIII activity was noted in tested patients (65%).
Conclusions:
- While randomized controlled trials are challenging, there is growing interest in VTE within pIBD.
- A consensus statement from multidisciplinary experts is recommended.
- This statement should be based on existing literature and clinical experience to guide management.
Objectives:
In addition to gastrointestinal symptoms, pediatric inflammatory bowel disease (pIBD) may present with extra-intestinal manifestations including venous thromboembolism (VTE). Prevention and treatment guidelines for VTE in pediatric patients are needed. In this scoping review, we sought to detail the available data on the prevention and management of VTE in pIBD.
Methods:
Using PRISMA extension for Scoping Reviews (PRISMA-ScR), we identified, screened, graded quality of, and analyzed, literature on VTE in pediatric IBD, published between 1967 and 2023.
Results:
Data were extracted from 107 studies (including 216 patients). IBD patients with VTE had a median age of 14 years. Children with VTE more frequently had ulcerative colitis (70%, n = 216), developed their VTE within the first year of IBD diagnosis (52%, n = 97), had recent steroid use (62%, n = 50), and had central venous catheters (38%, n = 42). Cerebral venous sinus thrombus was the most common VTE type (34% of all VTE). Testing for thrombophilia conditions was rarely available but 65% (n = 23) of subjects tested had elevated Factor VIII activity. While most patients made a full recovery, 5% (n = 11) died secondary to their VTE.
Conclusions:
While randomized clinical trials assessing interventions to prevent and treat VTE in pIBD would be ideal, the feasibility of doing such studies is low. However, there has been an increase in interest in this topic and an increase in literature over the past decade. As such, a consensus statement from a multidisciplinary group of experts based on available literature and clinical experience would be valuable for practicing clinicians.
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