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Risk Factors, Morbidity, and Treatment of Thrombosis in Children and Young Adults With Active Inflammatory Bowel Disease

Zitomersky, Naamah L.*; Levine, Anne E.*; Atkinson, Benjamin J.*; Harney, Kathy M.; Verhave, Menno*; Bousvaros, Athos*; Lightdale, Jenifer R.*; Trenor, Cameron C. III

Journal of Pediatric Gastroenterology & Nutrition:
doi: 10.1097/MPG.0b013e31829ce5cd
Original Articles: Gastroenterology
Abstract

Objectives: Pediatric inpatients with inflammatory bowel disease (IBD) are rarely considered for thromboprophylaxis because of concerns about safety and underappreciation of thrombotic risk. We characterized thromboembolism (TE) in children and young adults with inflammatory bowel disease (IBD) at a single tertiary care hospital.

Methods: We performed a retrospective review of an inpatient billing database for all IBD admissions with colonic involvement and an anticoagulation database for thrombotic complications from 2006 to 2011.

Results: Of 532 patients admitted with IBD with colonic involvement, 10 (1.9%) had TE (9 venous, 1 arterial), 2 of whom had recurrent thrombosis. Many of the events resulted in considerable morbidity, including 4 cerebrovascular events and 2 pulmonary emboli. Established risk factors in IBD colitis inpatients with TE included: indwelling catheter (4/10), first-degree family member with TE (2/10), hereditary thrombophilia (3/10), smoking (1/10), oral contraceptive (1/5 females), and thalidomide (1/10). Additionally, most (8/10) patients had acquired thrombophilia, mostly elevation of factor VIII and anticardiolipin antibodies. Patients with IBD and TE received therapeutic anticoagulation without significantly increased bleeding. Thrombus resolution was documented in 7 cases, persistence in 2 cases and recurrence in 2 cases.

Conclusions: Pediatric inpatients hospitalized with IBD with colonic involvement have increased risk of TE, including complications of pulmonary embolism, recurrence, persistence, and indefinite long-term anticoagulation. Therapeutic anticoagulation in patients with IBD with active colitis appears safe. We identified both inherited thrombophilias and acquired risk factors in patients with IBD and TE. We presently use risk stratification and recommend prophylactic anticoagulation in high-risk patients.

Author Information

*Division of Gastroenterology

Division of Hematology/Oncology, Boston Children's Hospital, Boston, MA.

Address correspondence and reprint requests to Naamah L. Zitomersky, MD, Division of Gastroenterology, Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02115 (e-mail: naamah.zitomersky@childrens.harvard.edu).

Received 7 March, 2013

Accepted 20 May, 2013

N.L.Z. is supported by Children's Hospital Boston Career Development Award; NASPGHAN CDHNF Fellow to Faculty Transition Award in Inflammatory Bowel Diseases. A.E.L. and J.R.L. are supported by a Patient Provider Quality Initiative Grant. B.J.A. is supported by the Rasmussen Family Fund. C.C.T. is supported by NIH/NHLBI K08 HL089509.

The authors report no conflicts of interest.

© 2013 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,