PB0283 - Impact of an Institutional Anticoagulant Thromboprophylaxis Protocol in Hospitalized Pediatric Patients with Inflammatory Bowel Disease at High Risk for Venous Thromboembolism

Background: The risk of venous thromboembolism (VTE) is increased in children with inflammatory bowel disease (IBD). VTE risk is greatest during hospitalization for IBD flare especially in the presence of additional VTE risk factors including-most importantly-the need for central venous catheter (CVC) placement. Moreover, VTE in children with IBD is associated with significant morbidity, mortality, and considerable health care costs. In 2015, we implemented an institutional anticoagulant thromboprophylaxis (AT) protocol with enoxaparin in high-risk patients-defined as any patient hospitalized with active IBD and requiring placement of a CVC.

Aims: To evaluate impact of implementation of an AT protocol in hospitalized pediatric patients with IBD at high risk for VTE.

Methods: We conducted a retrospective study of patients who were admitted to our center between 2017 and 2021 with active IBD and required a CVC. Relevant data extracted from the electronic medical records were summarized using descriptive statistics. Outcome measures included frequency of objectively confirmed VTE and frequency of major bleeding and/or clinically relevant nonmajor bleeding (CRNMB) defined according to the International Society on Thrombosis and Haemostasis criteria.

Results: During the study period, 52 unique patients (median age 16 years; 25 females) required 58 sequential hospital admissions with an IBD flare and required CVC placement, all of which were peripherally inserted central catheters (PICCs). AT was administered per protocol in 52 of 58 hospitalizations (90%). Two patients (4%) developed symptomatic PICC-related upper extremity deep vein thrombosis. One patient experienced AT-related CRNMB (2%). There were no AT-related major bleeding events and AT was not interrupted in any patient owing to worsening rectal bleeding, postoperative bleeding, or other bleeding complications.

Conclusion(s): Implementation of an institutional AT protocol in hospitalized pediatric patients with IBD at high risk for VTE was feasible and led to increased prescription of appropriate AT and low rates of VTEs and bleeding complications.