Venous Thromboembolism and Multiple Sclerosis

October 18, 2012

Venous thromboembolism is twice as likely to develop in patients with multiple sclerosis than in controls. Although the absolute risk of VTE is low in MS patients, thromboprophylaxis may need to be considered.

Venous thromboembolism (VTE), which comprises deep venous thrombosis (DVT) and pulmonary embolism (PE), is a common complication during and after hospitalization for acute medical illness or surgery. PE accounts for 5% to 10% of deaths in hospitalized patients, making VTE the most common preventable cause of in-hospital death.

VTE is twice as likely to develop in patients with MS than in controls.1 This risk is not solely associated with the short term after hospital admission: it is sustained over time. The elevated risk may be a reflection of immobility and the effects of treatment (eg, corticosteroids). It is also possible that it is a direct result of inflammation-a key determinant of endothelial function in both arteries and veins.

The absolute risk of VTE in MS patients is low and at least an order of magnitude lower than the risk of VTE after surgery. Nevertheless, given that a large proportion of hospitalized patients are at risk for VTE, and that there is, generally, a low rate of appropriate prophylaxis, patients with MS may need to be considered for thromboprophylaxis.

1. Ramagopalan SV, Wotton CJ, Handel AE, et al. Risk of venous thromboembolism in people admitted to hospital with selected immune-mediated diseases: record-linkage study. BMC Med. 2011;9:1.