The risk of venous thromboembolism in patients with multiple sclerosis: the Clinical Practice Research Datalink

Abstract

(1997)(1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008). At the time of MS diagnosis, a comparison cohort (N = 33 370) without a recorded MS diagnosis during the study period was matched (6:1) to the MS cohort (n = 5566) by birth year, sex, and practice. Subjects were followed from the index date until the occurrence of VTE, end of data collection, migration, or death, whichever came first. Cox proportional-hazards models were used to derive adjusted hazard ratios and 95% confidence intervals for VTE associated with MS and VTE risk factors within the MS cohort. Time-dependent adjustments were made for age, comorbidity, and medication use. Results: Compared with the comparison cohort, a 2.6-fold increased risk of VTE was observed for MS patients (adjusted hazard ratio 2.56, 95% confidence interval 2.06-3.20). A prior VTE event, varicose veins, obesity, and major trauma were found to be associated with an increased risk of VTE within the MS population. Moreover, the risk of VTE was increased in MS patients with recent records indicating immobility, spasticity, glucocorticoid use, or disability. Conclusions: Patients with MS had an increased risk of VTE. Furthermore, our results provide evidence that this association is, at least in part, mediated through an increased prevalence of VTE risk factors in MS patients.

Intravenous immune globulin and thromboembolic adverse events: A systematic review and meta‐analysis of RCTs

“…Most TEEs were observed in the six trials in patients with multiple sclerosis (who are at increased risk of VTE due to immobility and possibly other factors ), and in the three Alzheimer's disease trials which had considerably older patient populations (mean patient age was ∼70 years in these trials). While patients with multiple sclerosis and Alzheimer's disease are not typical IVIg users , their inclusion in this review does provide valuable information concerning the possible pro‐thrombotic effects of IVIg in patients with higher baseline risks of venous and/or arterial TEE.…”

Contraceptive use among women with multiple sclerosis: a systematic review

“…No evidence was found examining the effect of combined hormonal contraceptives on VTE risk among women with MS. Data from population-based, matched cohort studies from the United Kingdom and Sweden suggest that compared with those without MS, MS patients have an approximately threefold increased risk of VTE [12] or DVT [13], with lower risk found among females than males in one study [VTE adjusted hazard ratio (AHR) = 2.28, 95% CI = 1.73, 3.00 for females vs. AHR=3.16, CI=2.18, 4.57 for males] [12]. VTE risk also varies by MS type, with increased risk of DVT among those with progressive forms of the disease [relative risk (RR) = 3.57, CI=1.95, 6.56 for PPMS, RR=3.41, CI=2.45, 4.75 for SPMS, and RR=2.16, CI=1.21, 3.87 for RRMS] [13].…”

“…VTE risk also varies by MS type, with increased risk of DVT among those with progressive forms of the disease [relative risk (RR) = 3.57, CI=1.95, 6.56 for PPMS, RR=3.41, CI=2.45, 4.75 for SPMS, and RR=2.16, CI=1.21, 3.87 for RRMS] [13]. Among MS patients (females and males combined), risk factors for VTE included history of varicose veins, a prior VTE, obesity and recent (past 6 months) major trauma, spasticity, disability and corticosteroid use [12]. In this study, immobility was not examined separately but was considered as part of disability and spasticity which both interfere with normal movement.…”

“…MS patients have increased risk for venous thromboembolism (VTE) due to disability, immobility and autoinflammatory processes [12,13], which may be further increased with combined hormonal contraceptive use. MS patients may also have compromised bone health [14], so use of progestin-only injectables may be of concern.…”

Contraception for women with multiple sclerosis: Guidance for healthcare providers

“…This is because of inferred concerns about VTE risk. Although no evidence was found examining the effect of CHCs on VTE among women with MS, women with MS are at higher risk than unaffected women for VTE, 26,27 and CHCs increase VTE risk. 28 …”