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Incidence and risk factors for thromboembolic events in pediatric-onset inflammatory bowel disease: A French
Nicolas Richard1, Ariane Leroyer2, Delphine Ley3
1Univ Rouen Normandie, INSERM, ADEN UMR1073, "Nutrition, Inflammation and microbiota-gut-brain axis", CHU Rouen, Department of Gastroenterology, F-76000 Rouen, France.
Insights
Thromboembolic events (TE) risk is low in pediatric inflammatory bowel disease (IBD). Active disease, surgery, and hospitalization significantly increase venous thromboembolism (VTE) risk in these patients.
Area of Science:
- Pediatric Gastroenterology
- Thrombosis Research
- Epidemiology
Background:
- Patients with inflammatory bowel disease (IBD) face an elevated risk of thromboembolic events (TE).
- Limited population-level data exists on the incidence and risk factors for venous (VTE) and arterial events (ATE) in pediatric-onset IBD.
- Understanding these risks is crucial for developing effective thromboprophylaxis strategies in young IBD patients.
Purpose of the Study:
- To determine the incidence and risk factors of thromboembolic events (TE), specifically venous (VTE) and arterial events (ATE), in a pediatric population with inflammatory bowel disease (IBD).
- To provide data that can inform thromboprophylaxis guidelines for pediatric IBD patients.
Main Methods:
- A prospective, population-based registry (EPIMAD) was utilized, including patients aged 16 years or younger diagnosed with Crohn's disease (CD) or ulcerative colitis (UC) between 1988 and 2011.
- Patients were followed until 2013, with all recorded thromboembolic events (TE) during the follow-up period included in the analysis.
- Statistical analysis, including hazard ratios (HR), was employed to identify risk factors associated with VTE.
Main Results:
- A total of 1,344 pediatric IBD patients (1,007 CD, 337 UC) were analyzed with a median follow-up of 8.3 years.
- The overall incidence rate of TE was 1.32 per 1000 person-years, with 2 (0.15%) ATE and 15 (1.1%) VTE observed.
- Active disease (HR=8.4), the 3-month period post-surgery (HR=16.4), and hospitalization (HR=21.7) were significantly associated with increased VTE risk. Treatment with 5-aminosalicylates was associated with a lower VTE rate (HR=0.1).
Conclusions:
- The overall risk of thromboembolic events (TE) in this pediatric inflammatory bowel disease (IBD) cohort was found to be low.
- Venous thromboembolism (VTE) was strongly linked to periods of active disease, surgical interventions, and hospitalizations.
- These findings underscore the importance of monitoring and potentially intervening during these high-risk periods for VTE prevention in pediatric IBD.
Introduction:
Patients with inflammatory bowel disease (IBD) are at higher risk of thromboembolic events (TE). In pediatric-onset IBD, more data on incidence and risk factors of venous (VTE) and arterial events (ATE) at the population level are needed to guide thromboprophylaxis.
Methods:
All patients aged ≤ 16 years diagnosed with Crohn's disease (CD) or ulcerative colitis (UC) between 1988 and 2011 in the prospective EPIMAD population-based registry were followed until 2013. Every TE occurring during the follow-up period was included.
Results:
A total of 1,344 patients were included: 1,007 with CD and 337 with UC, and a median diagnosis age of 14.3 years. After a median follow-up of 8.3 years, 2 (0.15 %) ATE and 15 (1.1 %) VTE occurred at median age of 20.4 years. The global incidence rate of thromboembolic events was 1.32 per 1000 person-years. Periods of active disease (HR=8.4, p = 0.0002), the 3-month-period following surgery (HR=16.4, p = 0.0002) and hospitalization (HR=21.7, p < 0.0001) were found to be associated with an increased risk of VTE. A lower rate of VTE was found in patients treated with 5-aminosalicylates (HR=0.1, p = 0.002).
Conclusion:
The risk of TE was low in this population. VTE were strongly associated with active disease, surgery and hospitalization.
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