Venous thromboembolic (VTE) in patients with ALS: an incidence study

Abstract

ALS patients present risk factors associated with an increased incidence of VTE such as age or reduced mobility.

Aims: To analyze the incidence of deep vein thrombosis(DVT) and pulmonary thromboembolism(PE) in a cohort of ALS patients. To evaluate risk factors involved in VTE in ALS patients. To determine which subgroup of ALS patients could benefit from thromboembolic prophylaxis or VTE screening by monitoring D-dimer levels.

Methods: Observational and retrospective study in which 218 ALS patients of an ALS Multidisciplinary Unit were included from 2011 to 2021.Anthropometric variables, comorbidities,use of non-invasive mechanical ventilation(NIV),existence of tracheostomy, existence of thrombotic events or need for anticoagulant treatment were collected.

Results: In our cohort, 8 patients(3,9%)were diagnosed with VTE, of which 6 were DVT(2,8%)and 2 were PE (1,1%).Average age was 67 years, mean BMI 25.6 kg/m2,with 100% being sporadic ALS.Male/female ratio was 1:1.Continuous NIV was required in 50%(4).88% of the patients had been recently admitted for intercurrent infection. None of them had a tracheostomy. The use of continuous NIV was associated with VTE(p<0.001)as well as the presence of high blood pressure(HBP)(p<0.001)and obesity(p<0.001).No association was found with other described risk factors for VTE.Mortality in this group was 75%(6)due to disease progression(4)and sudden death in 2 of them.

Conclusions: The incidence of VTE in our cohort was 3,9%,higher than in the general population. There was a significant association between VTE and the use of continuous NIV as well as the presence of HBP and obesity. This subgroup of patients could benefit from closer monitoring of thrombotic risk and the indication of prophylaxis.