Systematic Reviews
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Apr 28, 2022; 28(16): 1705-1717
Published online Apr 28, 2022. doi: 10.3748/wjg.v28.i16.1705
Risk of venous thromboembolism in children and adolescents with inflammatory bowel disease: A systematic review and meta-analysis
Xin-Yue Zhang, Hai-Cheng Dong, Wen-Fei Wang, Yao Zhang
Xin-Yue Zhang, Hai-Cheng Dong, Wen-Fei Wang, Yao Zhang, Department of Traditional Chinese Medicine, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou 310005, Zhejiang Province, China
Author contributions: Wang CL, Liang L, Fu JF, Zou CC, Hong F and Wu XM designed the research; Wang CL, Zou CC, Hong F and Wu XM performed the research; Xue JZ and Lu JR contributed new reagents/analytic tools; Wang CL, Liang L and Fu JF analyzed the data; Wang CL, Liang L and Fu JF wrote the paper.
Conflict-of-interest statement: The authors have no conflicts of interest to disclose.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xin-Yue Zhang, MM, Attending Doctor, Department of Traditional Chinese Medicine, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, No. 57 Zhugan Lane, Xiancheng District, Hangzhou 310005, Zhejiang Province, China. cicelyxyz@zju.edu.cn
Received: August 19, 2021
Peer-review started: August 19, 2021
First decision: October 16, 2021
Revised: November 1, 2021
Accepted: March 27, 2022
Article in press: March 27, 2022
Published online: April 28, 2022
Processing time: 247 Days and 18.6 Hours
Abstract
BACKGROUND

A two- to three-fold increased risk of venous thrombotic events (VTE) has been demonstrated in patients with inflammatory bowel disease (IBD) compared to the general population, but less is known about the risk of VTE in child- and pediatric-onset IBD. In recent years, several studies have reported the rising incidence rate of VTE in juvenile patients with IBD, and the related risk factors have been explored.

AIM

To evaluate the risk of VTE in children and adolescents with IBD.

METHODS

Articles published up to April 2021 were retrieved from PubMed, Embase, Cochrane Library, Web of Science, SinoMed, CNKI, and WANFANG. Data from observational studies and clinical work were extracted. The outcome was the occurrence of VTE according to the type of IBD. The available odds ratio (OR) and the corresponding 95% confidence interval (CI) were extracted to compare the outcomes. Effect size (P), odds ratio (OR), and 95%CI were used to assess the association between VTE risk and IBD disease. Subgroup analyses stratified by subtypes of VTE and IBD were performed.

RESULTS

Twelve studies (7450272 IBD patients) were included in the meta-analysis. Child and adolescent IBD patients showed increased VTE risk (P = 0.02, 95%CI: 0.01-0.03). Subgroup analyses stratified by IBD (ulcerative colitis (UC): P = 0.05, 95%CI: 0.03-0.06; Crohn’s disease (CD): P = 0.02, 95%CI: 0.00-0.04) and VTE subtypes (portal vein thrombosis: P = 0.04, 95%CI: 0.02-0.06; deep vein thrombosis: P = 0.03, 95%CI: 0.01-0.05; central venous catheter-related thrombosis: P = 0.23, 95%CI: 0.00-0.46; thromboembolic events: P = 0.02, 95%CI: 0.01-0.03) revealed a significant correlation between VTE risk and IBD. Patients with IBD were more susceptible to VTE risk than those without IBD (OR = 2.99, 95%CI: 1.45-6.18). The funnel plot was asymmetric, suggesting the presence of significant publication bias. Pediatric and adolescent IBD patients have an increased VTE risk. UC and CD patients exhibited a high risk of VTE. The risk of VTE subtypes was increased in IBD patients.

CONCLUSION

The current meta-analysis showed that the incidence and risk of VTE are significantly increased in pediatric and adolescent IBD patients. Thus, IBD might be a risk factor for VTE in children and young adults. High-quality prospective cohort studies are necessary to confirm these findings.

Keywords: Thromboembolism; Children; Adolescents; Ulcerative colitis; Crohn’s disease; Meta-analysis

Core Tip: This study suggested that child and adolescent inflammatory bowel disease (IBD) patients showed an increased risk of venous thrombotic events (VTE) (P = 0.02, 95%CI: 0.01-0.03). Subgroup analysis stratified by IBD (ulcerative colitis: P = 0.04, 95%CI: 0.03-0.06; Crohn’s disease: P = 0.02, 95%CI: 0.00-0.04) and VTE subtypes (portal vein thrombosis: P = 0.04, 95%CI: 0.02-0.06; deep vein thrombosis: P = 0.03, 95%CI: 0.01-0.05; central venous catheter-related thrombosis: P = 0.13, 95%CI: 0.02-0.23; thromboembolic events: P = 0.02, 95%CI: 0.01-0.03) revealed a significant correlation between VTE incidence and IBD.