Thromboprophylaxis use in paediatric inflammatory bowel disease: an international RAND appropriateness panel

Torrente, F. et al. (2022) Thromboprophylaxis use in paediatric inflammatory bowel disease: an international RAND appropriateness panel. Journal of Crohn's and Colitis, 16(10), pp. 1609-1616. (doi: 10.1093/ecco-jcc/jjac073) (PMID:35608932) (PMCID:PMC9624289)

Abstract

Background and Aims: Thromboprophylaxis use in paediatric inflammatory bowel disease [IBD] is inconsistent. Current guidelines only support treating children with acute severe colitis with risk factors. We convened an international RAND panel to explore thromboprophylaxis in paediatric IBD inpatients in the context of new evidence. Methods: We convened a geographically diverse 14-person panel of paediatric gastroenterologists alongside supporting experts. An online survey was sent before an online meeting. Panellists were asked to rate the appropriateness of thromboprophylaxis in hospitalised paediatric IBD patients via 27 scenarios of varying ages, gender, and phenotype, with and without thrombotic risk factors. Anonymised results were presented at the meeting. A second modified survey was distributed to all panellists present at the meeting. Results from the second survey constitute the RAND panel results. The validated RAND disagreement index defined disagreement when ≥ 1. Results: The combined outcome of thromboprophylaxis being considered appropriate until discharge and inappropriate to withhold was seen in 20 of 27 scenarios, including: all patients with new-onset acute severe colitis; all flares of known ulcerative colitis, irrespective of risk factors except in pre-pubescent patients with limited disease and no risk factors; and all Crohn’s patients with risk factors. Disagreement was seen in five scenarios regarding Crohn’s without risk factors, where outcomes were already uncertain. Conclusions: RAND panels are an established method to assess expert opinion in areas of limited evidence. This work therefore constitutes neither a guideline nor a consensus; however, the findings suggest a need to re-evaluate the role of thromboprophylaxis in future guidelines.

• Item Type: Articles
• Additional Information: RH is supported by an NHS Research Scotland Career Researcher Fellowship. EB holds the Northbridge Financial Corporation Chair in Inflammatory Bowel Disease, a joint Hospital-University Chair between the University of Toronto, the Hospital for Sick Children, and the SickKids Foundation. DRM receives support through a Distinguished Clinical Research Chair in Pediatric IBD from the Faculty of Medicine, University of Ottawa.
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Hansen, Dr Richard
• Authors: Torrente, F., Meade, S., Benchimol, E. I., de Ridder, L., Croft, N. M., Kammermeier, J., Mack, D. R., Klomberg, R. C.W., Turner, D., Wilson, D. C., Martín-de-Carpi, J., Bronsky, J., Dias, J. A., Walker, G., van Ommen, C. H., Powar, M. P., Burgess, N., Irving, P. M., Samaan, M. A., and Hansen, R.
• College/School: College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
• Journal Name: Journal of Crohn's and Colitis
• Publisher: Oxford University Press
• ISSN: 1873-9946
• ISSN (Online): 1876-4479
• Published Online: 24 May 2022
• Copyright Holders: Copyright © 2022 The Authors
• First Published: First published in Journal of Crohn's and Colitis 16(10): 1609-1616
• Publisher Policy: Reproduced under a Creative Commons License