Hospitalized Children With IBD Face Thrombosis Risk

NATIONAL HARBOR, MD. — Hospitalized children and adolescents with inflammatory bowel disease had more than twice the risk for thrombotic events, compared with other hospitalized youth, in a retrospective cohort study that utilized a nationwide inpatient database.

Compared with the entire discharge population, the odds ratio for any thrombotic event among children and adolescents with inflammatory bowel disease (IBD) was 2.13. For those with ulcerative colitis, it was 1.72, and for Crohn's disease, it was 2.22. Among the individual events in all youth with IBD, the highest odds ratios were for Budd-Chiari syndrome (3.21), portal vein thrombosis (2.79), thrombophlebitis (2.75), and deep vein thrombosis (2.44).

IBD is associated with an increased risk for venous and arterial thrombosis in adults, but the risk of thrombosis in children with IBD has not been established previously, Dr. Cade M. Nylund and Dr. Lee A. Denson said in a poster at the annual meeting of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition.

Data were obtained from the Healthcare Cost and Utilization Project Kids' Inpatient Database—the first pediatric-specific inpatient database in the country—for the combined years 1997, 2000, 2003, and 2006 among children and teens aged 6–20 years. From a total weighted sample of 8,162,120 discharges, there were 34,298 thrombotic events and 49,280 children with IBD. Of the latter, 44,039 had Crohn's disease and 5,241 had ulcerative colitis, said Dr. Nylund and Dr. Denson of Cincinnati Children's Hospital Medical Center.

Thrombotic events were reported in 553 of the young people with IBD. They had a median age of 17 years (range 15–19), and a median length of stay of 8 days (5–15 days). More than half (55%) were male, 70% were white, and 17% were black. About two-thirds (68%) had peripherally inserted central catheter (PICC) lines, and 20% underwent surgery.

The overall absolute risk for any thrombotic event was 112.4/10,000 hospitalized IBD patients, compared with 44.5/10,000 for discharges overall. The rate of all thrombotic events was 87.8/10,000 for ulcerative colitis patients and 115.4/10,000 for Crohn's disease patients. IBD patients had significantly increased rates of deep vein thrombosis, thrombophlebitis, pulmonary embolism, portal vein thrombus, and Budd-Chiari syndrome, but not of cerebral vascular disease or arterial thrombus.

Demographic risk factors that significantly increased the risk for thrombotic events were the presence of a PICC line (3.6), age greater than 15 years (1.8), black vs. white race (1.4), and other races vs. white (1.3). Female gender was protective (0.49) among those with IBD, while surgery was not a risk factor, Dr. Nylund and Dr. Denson reported.

Dr. Nylund noted in an interview that the findings do not justify universal pharmacologic prophylaxis in hospitalized children and adolescents with IBD who have rectal bleeding, given the low absolute risk of thrombotic events in young people.

“However, in those more severe IBD children—such as those with prolonged hospitalization length of stay, and those requiring PICC lines—physicians should be aware of this increased risk of thrombotic events and seriously consider initiation of pharmacologic prophylaxis anticoagulation therapy,” he said. “Despite lacking evidence in the pediatric population for thromboembolism prevention techniques, conservative thrombotic prophylaxis such as frequent mobilization and pneumatic compression should at least be considered in all hospitalized children with IBD.”

Disclosures: Dr. Nylund and Dr. Denson had no conflicts of interest to report.

NATIONAL HARBOR, MD. — Hospitalized children and adolescents with inflammatory bowel disease had more than twice the risk for thrombotic events, compared with other hospitalized youth, in a retrospective cohort study that utilized a nationwide inpatient database.

Compared with the entire discharge population, the odds ratio for any thrombotic event among children and adolescents with inflammatory bowel disease (IBD) was 2.13. For those with ulcerative colitis, it was 1.72, and for Crohn's disease, it was 2.22. Among the individual events in all youth with IBD, the highest odds ratios were for Budd-Chiari syndrome (3.21), portal vein thrombosis (2.79), thrombophlebitis (2.75), and deep vein thrombosis (2.44).

IBD is associated with an increased risk for venous and arterial thrombosis in adults, but the risk of thrombosis in children with IBD has not been established previously, Dr. Cade M. Nylund and Dr. Lee A. Denson said in a poster at the annual meeting of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition.

Data were obtained from the Healthcare Cost and Utilization Project Kids' Inpatient Database—the first pediatric-specific inpatient database in the country—for the combined years 1997, 2000, 2003, and 2006 among children and teens aged 6–20 years. From a total weighted sample of 8,162,120 discharges, there were 34,298 thrombotic events and 49,280 children with IBD. Of the latter, 44,039 had Crohn's disease and 5,241 had ulcerative colitis, said Dr. Nylund and Dr. Denson of Cincinnati Children's Hospital Medical Center.

Thrombotic events were reported in 553 of the young people with IBD. They had a median age of 17 years (range 15–19), and a median length of stay of 8 days (5–15 days). More than half (55%) were male, 70% were white, and 17% were black. About two-thirds (68%) had peripherally inserted central catheter (PICC) lines, and 20% underwent surgery.

The overall absolute risk for any thrombotic event was 112.4/10,000 hospitalized IBD patients, compared with 44.5/10,000 for discharges overall. The rate of all thrombotic events was 87.8/10,000 for ulcerative colitis patients and 115.4/10,000 for Crohn's disease patients. IBD patients had significantly increased rates of deep vein thrombosis, thrombophlebitis, pulmonary embolism, portal vein thrombus, and Budd-Chiari syndrome, but not of cerebral vascular disease or arterial thrombus.

Demographic risk factors that significantly increased the risk for thrombotic events were the presence of a PICC line (3.6), age greater than 15 years (1.8), black vs. white race (1.4), and other races vs. white (1.3). Female gender was protective (0.49) among those with IBD, while surgery was not a risk factor, Dr. Nylund and Dr. Denson reported.

Dr. Nylund noted in an interview that the findings do not justify universal pharmacologic prophylaxis in hospitalized children and adolescents with IBD who have rectal bleeding, given the low absolute risk of thrombotic events in young people.

“However, in those more severe IBD children—such as those with prolonged hospitalization length of stay, and those requiring PICC lines—physicians should be aware of this increased risk of thrombotic events and seriously consider initiation of pharmacologic prophylaxis anticoagulation therapy,” he said. “Despite lacking evidence in the pediatric population for thromboembolism prevention techniques, conservative thrombotic prophylaxis such as frequent mobilization and pneumatic compression should at least be considered in all hospitalized children with IBD.”

Disclosures: Dr. Nylund and Dr. Denson had no conflicts of interest to report.

NATIONAL HARBOR, MD. — Hospitalized children and adolescents with inflammatory bowel disease had more than twice the risk for thrombotic events, compared with other hospitalized youth, in a retrospective cohort study that utilized a nationwide inpatient database.

Compared with the entire discharge population, the odds ratio for any thrombotic event among children and adolescents with inflammatory bowel disease (IBD) was 2.13. For those with ulcerative colitis, it was 1.72, and for Crohn's disease, it was 2.22. Among the individual events in all youth with IBD, the highest odds ratios were for Budd-Chiari syndrome (3.21), portal vein thrombosis (2.79), thrombophlebitis (2.75), and deep vein thrombosis (2.44).

IBD is associated with an increased risk for venous and arterial thrombosis in adults, but the risk of thrombosis in children with IBD has not been established previously, Dr. Cade M. Nylund and Dr. Lee A. Denson said in a poster at the annual meeting of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition.

Data were obtained from the Healthcare Cost and Utilization Project Kids' Inpatient Database—the first pediatric-specific inpatient database in the country—for the combined years 1997, 2000, 2003, and 2006 among children and teens aged 6–20 years. From a total weighted sample of 8,162,120 discharges, there were 34,298 thrombotic events and 49,280 children with IBD. Of the latter, 44,039 had Crohn's disease and 5,241 had ulcerative colitis, said Dr. Nylund and Dr. Denson of Cincinnati Children's Hospital Medical Center.

Thrombotic events were reported in 553 of the young people with IBD. They had a median age of 17 years (range 15–19), and a median length of stay of 8 days (5–15 days). More than half (55%) were male, 70% were white, and 17% were black. About two-thirds (68%) had peripherally inserted central catheter (PICC) lines, and 20% underwent surgery.

The overall absolute risk for any thrombotic event was 112.4/10,000 hospitalized IBD patients, compared with 44.5/10,000 for discharges overall. The rate of all thrombotic events was 87.8/10,000 for ulcerative colitis patients and 115.4/10,000 for Crohn's disease patients. IBD patients had significantly increased rates of deep vein thrombosis, thrombophlebitis, pulmonary embolism, portal vein thrombus, and Budd-Chiari syndrome, but not of cerebral vascular disease or arterial thrombus.

Demographic risk factors that significantly increased the risk for thrombotic events were the presence of a PICC line (3.6), age greater than 15 years (1.8), black vs. white race (1.4), and other races vs. white (1.3). Female gender was protective (0.49) among those with IBD, while surgery was not a risk factor, Dr. Nylund and Dr. Denson reported.

Dr. Nylund noted in an interview that the findings do not justify universal pharmacologic prophylaxis in hospitalized children and adolescents with IBD who have rectal bleeding, given the low absolute risk of thrombotic events in young people.

“However, in those more severe IBD children—such as those with prolonged hospitalization length of stay, and those requiring PICC lines—physicians should be aware of this increased risk of thrombotic events and seriously consider initiation of pharmacologic prophylaxis anticoagulation therapy,” he said. “Despite lacking evidence in the pediatric population for thromboembolism prevention techniques, conservative thrombotic prophylaxis such as frequent mobilization and pneumatic compression should at least be considered in all hospitalized children with IBD.”

Disclosures: Dr. Nylund and Dr. Denson had no conflicts of interest to report.