Risk factors, morbidity, and treatment of thrombosis in children and young adults with active inflammatory bowel disease.
Risk factors, morbidity, and treatment of thrombosis in children and young adults with active inflammatory bowel disease.
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患有活动性炎症性肠病的儿童和年轻人血栓形成的危险因素、发病率和治疗。
DOI：
10.1097/mpg.0b013e31829ce5cd
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发表时间：
2013
影响因子：
2.9
通讯作者：
Trenor3rd,CameronC
中科院分区：
文献类型：
--
作者：
Zitomersky,NaamahL;Levine,AnneE;Atkinson,BenjaminJ;Harney,KathyM;Verhave,Menno;Bousvaros,Athos;Lightdale,JeniferR;Trenor3rd,CameronC
目的：由于对安全性的担忧和对血栓形成风险的低估，很少考虑对患有炎症性肠病（IBD）的儿科住院患者进行血栓预防。我们的特点血栓栓塞（TE）的儿童和年轻人与炎症性肠病（IBD）在一个单一的三级保健hospital.Methods：我们进行了回顾性审查的住院帐单数据库的所有IBD入院与结肠受累和抗凝数据库血栓并发症从2006年至2011年。结果：532例IBD与结肠受累，10（1.9%）有TE（9静脉，1动脉），其中2人复发血栓形成。许多事件导致相当高的发病率，包括4例脑血管事件和2例肺栓塞。IBD结肠炎住院TE患者中确定的风险因素包括：留置导管（4/10）、TE一级家族成员（2/10）、遗传性血栓形成倾向（3/10）、吸烟（1/10）、口服避孕药（1/5女性）和沙利度胺（1/10）。此外，大多数（8/10）患者有获得性血栓形成倾向，主要是因子VIII和抗心磷脂抗体升高。IBD和TE患者接受了抗凝治疗，未显著增加出血。血栓决议记录在7例，持续性2例，复发cases.Conclusions：小儿住院IBD与结肠受累TE的风险增加，包括并发症肺栓塞，复发，持续性，和无限期长期抗凝治疗。IBD伴活动性结肠炎患者的抗凝治疗似乎是安全的。我们确定了IBD和TE患者的遗传性血栓形成倾向和获得性危险因素。我们目前使用危险分层，并建议对高危患者进行预防性抗凝治疗。
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.