Paediatric inflammatory bowel disease may increase incidence of VTE, finds study

Canada has reported the highest incidence of paediatric Inflammatory Bowel Disease (IBD) in the world. IBD is a group of intestinal disorders that cause inflammation of the gut. Recent studies suggest venous thromboembolism (VTE) is a well-known complication of inflammatory bowel disease (IBD) in adults, however limited data exist about the risk in children. M. Ellen Kuenzig and their team reported the incidence of VTE among children with and without IBD. The study has been published in Journal of Crohn's and Colitis.

The objective of the study was to evaluate the risks of occurrence of VTE Venous thromboembolism in children with IBD and those without IBD. Risks in children has very limited amount of data presented so far, hence the study was designed to evaluate the risks.

The researchers conducted a matched cohort study within a distributed network of population-based Canadian provincial health administrative databases. Children below 16 years diagnosed with IBD were identified using validated algorithms from administrative data in Alberta, Manitoba, Nova Scotia, Ontario, and Québec and compared to age and sex-matched children without IBD. Hospitalizations for VTE within five years of IBD diagnosis were identified. Generalized linear mixed-effects models were used to pool province-specific incidence rates and incidence rate ratios (IRR) with 95% confidence intervals (CI). Hazard ratios (HR) from Cox proportional hazards models were pooled with fixed-effects meta-analysis.

The researchers found that the 5-year incidence of VTE among 3593 children with IBD was 31.2 [95% CI 23.7–41.0] per 10 000 person-years [PY] compared to 0.8 [95% CI 0.4–1.7] per 10 000 PY among 16 289 children without IBD [unadjusted IRR 38.84, 95% CI 16.59–90.83; adjusted HR 22.91, 95% CI 11.50–45.63]. VTE was less common in Crohn's disease than ulcerative colitis [unadjusted IRR 0.47, 95% CI 0.27– 0.83; adjusted HR 0.52, 95% CI 0.29–0.94]. The findings were similar for deep vein thrombosis and pulmonary embolism when comparing children with and without IBD.

The researchers concluded that "The risk of VTE is much higher in children with IBD than controls without IBD. While the absolute risk is low, we found a higher incidence rate than previously described in the pediatric literature." They also suggested that "Future research should assess the risks and benefits of thromboprophylaxis in this population, as well as identify patients at greatest risk based on clinical, biological and demographic criteria with the goal of informing clinical practice guidelines on the use of VTE prophylaxis in paediatric IBD."

For further information : https://doi.org/10.1093/ecco-jcc/jjab113.