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Increased Rate of Venous Thromboembolism in Hospitalized Inflammatory Bowel Disease Patients with Clostridium Difficile Infection

Bhandari, Sanjay MD*; Mohammed Abdul, Mubeen Khan MD; Dhakal, Binod MD; Kreuziger, Lisa Baumann MD; Saeian, Kia MD§; Stein, Daniel MD§

doi: 10.1097/MIB.0000000000001218
Original Clinical Articles

Background: Risk of venous thromboembolism (VTE) in patients with inflammatory bowel disease (IBD) is well established; however, there is paucity of data on the potential added risk of VTE in patients with IBD with Clostridium difficile infection (CDI). We sought to study the difference in VTE rates in hospitalized patients with IBD with CDI compared to those without CDI.

Methods: We queried Nationwide Inpatient Sample from year 2011 to identify patients ≥18 years of age with a discharge diagnosis of IBD (i.e., Crohn's disease and ulcerative colitis) based on ICD-9-CM codes 555.xx and 556.xx, respectively. Patients were further divided into 2 groups: those with and without CDI. To adjust and control for potential baseline differences between groups, 1:1 propensity matching was performed. Multivariate regression analysis was used to evaluate the difference in VTE rates in 2 groups.

Results: Of 312,147 patients with the discharge diagnosis of IBD, 12,560 (4%) had CDI. VTE was present 6% in group with CDI versus 3% in group without CDI (P < 0.001). On performing multivariate analysis after propensity-score matching, CDI was significantly associated with VTE (adjusted odds ratio 1.7, 95% confidence interval 1.4–2.2, P < 0.001). On subgroup analysis, Crohn's disease with CDI had a higher association with VTE compared with Crohn's disease only. Similarly, ulcerative colitis with CDI had a higher association with VTE compared with ulcerative colitis only.

Conclusions: Rate of VTE was higher in hospitalized patients with IBD with CDI compared with those without CDI, necessitating extra vigilance in this patient population.

Article first published online 22 August 2017.Supplemental Digital Content is Available in the Text.

*Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin;

Aurora Saint Luke's Medical Center, Milwaukee, Wisconsin;

Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin; and

§Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, Wisconsin.

Address correspondence to: Sanjay Bhandari, MD, Division of General Internal Medicine, Froedtert & the Medical College of Wisconsin, 9200 West Wisconsin Avenue, 5th Floor Cancer Center, Milwaukee, WI 53226 (e-mail:

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (

The authors have no conflict of interest to disclose.

Received February 10, 2017

Accepted June 07, 2017

© Crohn's & Colitis Foundation
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