title: Colectomy is a risk factor for venous thromboembolism in ulcerative colitis.
abstract: OBJECTIVE
  To compare venous thromboembolism (VTE) in hospitalized ulcerative colitis (UC) patients who respond to medical management to patients requiring colectomy.
  
  
  METHODS
  Population-based surveillance from 1997 to 2009 was used to identify all adults admitted to hospital for a flare of UC and those patients who underwent colectomy. All medical charts were reviewed to confirm the diagnosis and extract clinically relevant information. UC patients were stratified by: (1) responsive to inpatient medical therapy (n=382); (2) medically refractory requiring emergent colectomy (n=309); and (3) elective colectomy (n=329). The primary outcome was the development of VTE during hospitalization or within 6 mo of discharge. Heparin prophylaxis to prevent VTE was assessed. Logistic regression analysis determined the effect of disease course (i.e., responsive to medical therapy, medically refractory, and elective colectomy) on VTE after adjusting for confounders including age, sex, smoking, disease activity, comorbidities, extent of disease, and IBD medications (i.e., corticosteroids, mesalamine, azathioprine, and infliximab). Point estimates were presented as odds ratios (OR) with 95%CI.
  
  
  RESULTS
  The prevalence of VTE among patients with UC who responded to medical therapy was 1.3% and only 16% of these patients received heparin prophylaxis. In contrast, VTE was higher among patients who underwent an emergent (8.7%) and elective (4.9%) colectomy, despite greater than 90% of patients receiving postoperative heparin prophylaxis. The most common site of VTE was intra-abdominal (45.8%) followed by lower extremity (19.6%). VTE was diagnosed after discharge from hospital in 16.7% of cases. Elective (adjusted OR=3.69; 95%CI: 1.30-10.44) and emergent colectomy (adjusted OR=5.28; 95%CI: 1.93-14.45) were significant risk factors for VTE as compared to medically responsive UC patients. Furthermore, the odds of a VTE significantly increased across time (adjusted OR=1.10; 95%CI: 1.01-1.20). Age, sex, comorbidities, disease extent, disease activity, smoking, corticosteroids, mesalamine, azathioprine, and infliximab were not independently associated with the development of VTE.
  
  
  CONCLUSIONS
  VTE was associated with colectomy, particularly, among UC patients who failed medical management. VTE prophylaxis may not be sufficient to prevent VTE in patients undergoing colectomy.
authors: Gilaad G Kaplan, Allen Lim, Cynthia H Seow, Gordon W Moran, Subrata Ghosh, Yvette Leung, James Hubbard, Remo Panaccione, Inflammatory Bowel Disease Clinic, University of Calgary, Calgary AB T2N 4N1, Canada.
authors: Gilaad G
authors: GG
authors: Kaplan
authors: Gilaad G Kaplan, Allen Lim, Cynthia H Seow, Gordon W Moran, Subrata Ghosh, Yvette Leung, James Hubbard, Remo Panaccione, Inflammatory Bowel Disease Clinic, University of Calgary, Calgary AB T2N 4N1, Canada.
authors: Allen
authors: A
authors: Lim
authors: Gilaad G Kaplan, Allen Lim, Cynthia H Seow, Gordon W Moran, Subrata Ghosh, Yvette Leung, James Hubbard, Remo Panaccione, Inflammatory Bowel Disease Clinic, University of Calgary, Calgary AB T2N 4N1, Canada.
authors: Cynthia H
authors: CH
authors: Seow
authors: Gilaad G Kaplan, Allen Lim, Cynthia H Seow, Gordon W Moran, Subrata Ghosh, Yvette Leung, James Hubbard, Remo Panaccione, Inflammatory Bowel Disease Clinic, University of Calgary, Calgary AB T2N 4N1, Canada.
authors: Gordon W
authors: GW
authors: Moran
authors: Gilaad G Kaplan, Allen Lim, Cynthia H Seow, Gordon W Moran, Subrata Ghosh, Yvette Leung, James Hubbard, Remo Panaccione, Inflammatory Bowel Disease Clinic, University of Calgary, Calgary AB T2N 4N1, Canada.
authors: Subrata
authors: S
authors: Ghosh
authors: Gilaad G Kaplan, Allen Lim, Cynthia H Seow, Gordon W Moran, Subrata Ghosh, Yvette Leung, James Hubbard, Remo Panaccione, Inflammatory Bowel Disease Clinic, University of Calgary, Calgary AB T2N 4N1, Canada.
authors: Yvette
authors: Y
authors: Leung
authors: Gilaad G Kaplan, Allen Lim, Cynthia H Seow, Gordon W Moran, Subrata Ghosh, Yvette Leung, James Hubbard, Remo Panaccione, Inflammatory Bowel Disease Clinic, University of Calgary, Calgary AB T2N 4N1, Canada.
authors: Jennifer
authors: J
authors: Debruyn
authors: Gilaad G Kaplan, Allen Lim, Cynthia H Seow, Gordon W Moran, Subrata Ghosh, Yvette Leung, James Hubbard, Remo Panaccione, Inflammatory Bowel Disease Clinic, University of Calgary, Calgary AB T2N 4N1, Canada.
authors: Geoffrey C
authors: GC
authors: Nguyen
authors: Gilaad G Kaplan, Allen Lim, Cynthia H Seow, Gordon W Moran, Subrata Ghosh, Yvette Leung, James Hubbard, Remo Panaccione, Inflammatory Bowel Disease Clinic, University of Calgary, Calgary AB T2N 4N1, Canada.
authors: James
authors: J
authors: Hubbard
authors: Gilaad G Kaplan, Allen Lim, Cynthia H Seow, Gordon W Moran, Subrata Ghosh, Yvette Leung, James Hubbard, Remo Panaccione, Inflammatory Bowel Disease Clinic, University of Calgary, Calgary AB T2N 4N1, Canada.
authors: Remo
authors: R
authors: Panaccione
mesh_terms: D000293:Adolescent; D000328:Adult; D000925:Anticoagulants / Q000627:therapeutic use; D003082:Colectomy / Q000009:adverse effects*; D003093:Colitis, Ulcerative / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy* / Q000601:surgery*; D017558:Elective Surgical Procedures; D004630:Emergencies; D005260:Female; D005765:Gastrointestinal Agents / Q000009:adverse effects / Q000627:therapeutic use*; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D054556:Venous Thromboembolism / Q000209:etiology* / Q000517:prevention & control; D055815:Young Adult
chemical_list: D000925:Anticoagulants; D005765:Gastrointestinal Agents; D006493:Heparin
keywords: Deep vein thrombosis; Inflammatory bowel diseases; Pulmonary embolism; Surgery; Ulcerative colitis
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