Occurrence of Thromboembolism in Paediatric Patients With Inflammatory Bowel Disease: Data From the CEDATA-GPGE Registry

Jan De Laffolie; Antje Ballauff; Stefan Wirth; Carolin Blueml; Frank Risto Rommel; Martin Claßen; Martin Laaß; Thomas Lang; Almuthe Christina Hauer; CEDATA-GPGE Study Group

doi:10.3389/fped.2022.883183

Occurrence of Thromboembolism in Paediatric Patients With Inflammatory Bowel Disease: Data From the CEDATA-GPGE Registry

Front Pediatr. 2022 Jun 3:10:883183. doi: 10.3389/fped.2022.883183. eCollection 2022.

Authors

Jan De Laffolie¹, Antje Ballauff², Stefan Wirth³, Carolin Blueml⁴, Frank Risto Rommel¹, Martin Claßen⁵, Martin Laaß⁶, Thomas Lang⁷, Almuthe Christina Hauer⁸; CEDATA-GPGE Study Group

Affiliations

¹ Department of General Pediatrics and Neonatology, University of Giessen, Giessen, Germany.
² Kinderklinik, Helios Klinikum Krefeld, Krefeld, Germany.
³ Kinderklinik, Helios Klinikum Wuppertal, Wuppertal, Germany.
⁴ Department of Paediatrics, Philipps-University Marburg, Marburg, Germany.
⁵ Klinikum Links der Weser, Bremen, Germany.
⁶ Children's Hospital, Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
⁷ Kinderklinik Regensburg, Regensburg, Germany.
⁸ Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria.

Abstract

Objective: Among patients with inflammatory bowel disease (IBD), the risk of thromboembolism (TE) is increased, representing a relevant cause of morbidity and mortality. In contrast to other extraintestinal IBD manifestations, TE receives much less attention because of its low incidence, estimated at merely 0.4-0.9% in hospitalised children with IBD.

Methods: Cases with TE, as documented in the German-Austrian Paediatric IBD registry gesellschaft für pädiatrische gastroenterologie und ernährung - large paediatric patient registry (CEDATA-GPGE), were analyzed retrospectively. For all patients with signs of TE, a questionnaire was filled in by the treating paediatric gastroenterologist.

Results: Over 10 years, 4,153 paediatric patients with IBD (0-18 years) were registered in the registry, and 12 of them identified with TE. Eight patients were diagnosed with ulcerative colitis (UC), three with Crohn's disease (CD), and one with IBD-unclassified. The median age at IBD diagnosis was 10 years and at the manifestation of TE 13 years, respectively, with a median latency to TE of 2 years. Prevalence of TE was 0.3%, with a significantly higher risk for patients with UC than CD (OR 5.9, CI 1.56-22.33, p = 0.008). More girls than boys were affected (f:m = 7:5) without reaching significance. Approximately 90% of patients experienced TE during active disease, with relevant cerebral and limb involvement in 6/12 patients. Various risk factors, e.g., hospitalisation, coagulopathy, or anaemia were identified. TE management included intensive care and surgery. Among the 12 patients, 11 recovered fully, in which one patient has focal epilepsy as a sequela.

Conclusion: Paediatric patients with IBD have a substantially increased risk for TE. Risk factors, such as those identified should be considered when managing paediatric IBD and preventive measures for those hospitalised taken routinely. Initiating pharmacological thromboprophylaxis is challenging for the lack of published trials on efficacy and safety in paediatric IBD but should be considered carefully in each case.

Keywords: Crohn’s disease; IBD; children; colitis; inflammatory bowel disease; paediarics; thromboembolism.