Meta-analysis finds increased VTE risk in pediatric IBD, especially ulcerative colitis
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Key Takeaway
Consider heightened VTE risk in pediatric IBD, especially ulcerative colitis.
This systematic review and meta-analysis pooled data from studies involving 101,253 children and teenagers with inflammatory bowel disease (IBD) and 19,651,587 non-IBD controls. The analysis compared the risk of venous thromboembolism (VTE) between these groups, with secondary outcomes of deep vein thrombosis (DVT) and pulmonary embolism (PE).
The main finding was a significantly increased relative risk (RR) of overall VTE in pediatric IBD patients (RR = 6.94, 95% CI [1.87-25.69], p = 0.004). The risk of DVT was also significantly elevated (RR = 6.25, 95% CI [1.13-34.69], p = 0.036). The risk of PE was increased but did not reach statistical significance (RR = 3.13, 95% CI [0.96-10.19], p = 0.058). The risk was higher in patients with ulcerative colitis (UC) (RR = 7.53, 95% CI [2.97-19.10], p < 0.001) than in those with Crohn's disease (CD) (RR = 3.69, 95% CI [1.67-8.17], p = 0.001). The unadjusted VTE risk was higher (RR = 8.19) than the adjusted risk (RR = 4.53), suggesting other factors contribute to the overall risk.
Safety and tolerability data were not reported. Key limitations of the included studies, such as heterogeneity and potential confounding, were not detailed in the input. The practice relevance suggests VTE prevention strategies should be emphasized in children and teenagers with IBD, particularly those with ulcerative colitis, though the evidence is observational and the absolute risk remains undefined.
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View Original Abstract ↓
BACKGROUND: The increased risk of venous thromboembolism (VTE) in adults with inflammatory bowel disease (IBD) is well known, but we know less about the VTE risk of IBD in children and teenagers. We evaluated the risk of VTE in children and teenagers through systematic review and meta-analysis.
METHODS: A systematic search was conducted in PubMed, Embase, Cochrane Library, Web of Science for studies from the establishment of these databases to February 10, 2026, to find relevant research on the risk of VTE in children and teenagers with IBD (PROSPERO, ID: CRD420251081653). Random-effects and fixed-effects models were used to estimate the relative risk (RR) and the corresponding 95% confidence interval (CI). The quality of the included studies was evaluated using the Newcastle-Ottawa Scale.
RESULTS: Seven cohort studies were included in this systematic review, involving 101,253 children and teenagers with IBD and 19,651,587 non-IBD controls. Compared with non-IBD children and teenagers, the overall RR of VTE in children and teenagers with IBD was 6.94 (95% CI [1.87-25.69], = 0.004). The risk of deep vein thrombosis (DVT) in children and teenagers with IBD was increased (RR = 6.25, 95% CI [1.13-34.69], = 0.036); the risk of pulmonary thromboembolism (PE) in children and teenagers with IBD was also increased, but there was no statistically significant difference (RR = 3.13, 95% CI [0.96-10.19], = 0.058). Children and teenagers with ulcerative colitis (UC) have a higher risk of VTE (RR = 7.53, 95% CI [2.97-19.10], < 0.001) than those with Crohn's disease (CD) (RR = 3.69, 95% CI [1.67-8.17], = 0.001). The unadjusted VTE risk in children and teenagers with IBD (RR = 8.19, 95% CI [2.29-29.32], = 0.001) was higher than the adjusted VTE risk for confounding factors (RR = 4.53, 95% CI [1.91-10.77], = 0.001).
CONCLUSIONS: Children and teenagers with IBD are at a significantly increased risk of developing VTE. Therefore, VTE prevention strategies should be emphasized in this population as well as in adults.
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