Deep vein thrombosis in patients with neuromuscular disease who undergo tracheotomy with positive pressure ventilation

Abstract

Background Deep vein thrombosis and its progression to pulmonary thromboembolism is a major source of mortality in patients with neuromuscular disease. Furthermore, ventilator use poses a high risk of DVT to patients. Methods Hospitalized patients with neuromuscular disease who underwent tracheotomy with positive pressure ventilation (TPPV) had DVT evaluated in the lower extremities by ongoing whole leg venous ultrasonography. Patients who were diagnosed with DVT underwent a second ultrasonography 1 month later. The attending physicians decided on therapeutic measures. All patients were followed during the study period. Results Eight of 33 patients had DVT. The site of DVT formation was the iliac veins in three cases, femoral veins in two cases, and calf veins in three cases. All of the patients with DVT were asymptomatic. There was no difference in the clinical future between patients with DVT and those without DVT. Progression of DVT was not observed in the second ultrasonographic examination 1 month later. All patients with DVT had an excellent prognosis after a follow‐up period of 9 months. Conclusion The prevalence of DVT in patients with neuromuscular disease who undergo TPPV might be high. Further large studies on this issue are required because the clinical significance of this DVT is uncertain.

Prevalence of co-morbidity and history of recent infection in patients with neuromuscular disease: A cross-sectional analysis of United Kingdom primary care data

“…The prevalence of DVT in patients with NMD could be presumed to be higher because patients typically have reduced physical activity and may adopt a more sedentary lifestyle [ 30 ]. While DVT has been reported as an important cause of mortality in patients with amyotrophic lateral sclerosis and Parkinson disease, there has been limited reporting with other NMD [ 31 ]. Although we queried the co-existence of the MS and GBS diagnoses, a case-control study has shown an association between GBS and prior infections such as Epstein-Barr virus [ 32 ], which is also thought to be a risk factor for MS [ 33 ]; so a more forensic analysis, ideally studied prospectively, is necessary here to understand our finding further.…”