Laura Hamant, MD: Standardized Algorithm Increases VTE Prophylaxis Among Children

Laura G. Hamant, MD

Credit: Nationwide Children’s Hospital

A recent study found the introduction of a standardized algorithm was linked to an increased number of children with inflammatory bowel disease (IBD) who received venous thromboembolism (VTE) prophylaxis. Not only that, but the algorithm led more children to receive the appropriate VTE prophylaxis.

Children with IBD are at an increased risk for VTE, a condition that can be life-threatening. However, as opposed to adults hospitalized with IBD who routinely receive VTE prophylaxis with enoxaparin, it is rare for pediatricians to follow these standardized protocols.

The study, presented at the 2024 Annual North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) Meeting in Hollywood, Florida, from November 7 to 9, 2024, aimed to increase the rate of appropriate medication prophylaxis for VTE among hospitalized pediatric patients with IBD using quality improvement methodology. Led by Laura G. Hamant, MD, from the division of Pediatric Gastroenterology at Nationwide Children’s Hospital in Columbus, Ohio, the team created an algorithm for providing VTE prophylaxis using current evidence, algorithms from other institutions, and multidisciplinary collaboration between hematology, pharmacy, and surgery.

The algorithm recommends patients with IBD who have moderate to severe colitis, or severe ileitis with 1 other risk factor, for enoxaparin prophylaxis. For those who do not meet the criteria, the investigators encourage early mobilization, compression stockings, and sequential compression devices.

The algorithm was implemented in February 2023 for all patients (n = 199; mean age: 15.6 years; 47% female) admitted to a large, tertiary care children’s hospital with active IBD. Among the sample, 67% had Crohn's disease, 32% had ulcerative colitis, and 1% had IBD-unclassified. Four patients received enoxaparin (1%).

Rates of appropriate VTE prophylaxis, defined as patients who correctly received or did not receive enoxaparin according to the algorithm, were compared from baseline (January 2021 – January 2023) to the study period (February 2023 – April 2024). Ultimately, 93.8% of patients had an appropriate VTE prophylaxis—hence investigators met their goal of providing appropriate medication prophylaxis to > 90% of hospitalized patients with IBD by June 2023.

Investigators observed the total number of patients that received medication prophylaxis, as well as received appropriate medication prophylaxis per the algorithm, both significantly increased following the study period (P < .001).

At NASPGHAN, HCPLive spoke with Hamant about the success of the algorithm and areas for future research.

HCPLive:

Can you describe what your study is about?

Hamant: This is a quality effort [improvement] project that we implemented in our [VTE prophylaxis for] IBD patients, and we kind of saw the results of how we increased our [prophylaxis rates].

HCPLive:

What would you highlight as the biggest takeaway of the project?

Hamant: The biggest takeaway would be that implementing an algorithm at an institution can increase the utilization of [VTE prophylaxis].

HCPLive:

Can you talk more about this algorithm?

Hamant: So, essentially, what it boils down to is that any hospitalized IBD patient who has moderate to severe colitis or severe ileitis qualifies for pharmacologic [VTE prophylaxis] with [enoxaparin], and that’s sort of what we followed with our [QI] project—if we appropriately followed the algorithm to give them medication.

HCPLive:

What areas are there for future research?

Hamant: One of the biggest gaps in the research would be that we have not really proved the efficacy of [VTE prophylaxis] in IBD patients. That's because VTE] is such a rare event in [children] and that risk is elevated significantly in IBD, but we don't have good trials with the numbers of patients needed to prove that we are preventing VTE in a statistically significant manner.

References

^{Hamant, L, Dotson, B, Maltz, R, et al. IMPROVING VENOUS THROMBOEMBOLISM PROPHYLAXIS IN HOSPITALIZED PATIENTS WITH INFLAMMATORY BOWEL DISEASE. Presented at NASPHGAN 2024 in Hollywood, Florida, from November 7 – November 9, 2024.}