Risk of deep venous thrombosis (DVT) in bedridden or wheelchair-bound multiple sclerosis patients: a prospective study.
BACKGROUND
Multiple sclerosis (MS) often causes progressive loss of mobility, leading to limb paralysis. Venous and lymphatic stasis is a risk condition for venous thromboembolism (VTE). There is, however, no data on the frequency of VTE complicating the progression of MS. The aim of this study was to assess the frequency of deep vein thrombosis (DVT) in patients with late-stage MS attending a neurology center for rehabilitation.


METHODS
A total of 132 patients with MS were enrolled, 87 women and 45 men, mean age 58+/-11 years. The disease had started on average 18.7 years before; patients reported 9.6 hours bedridden per day or 14.3 hours wheelchair-bound. Only 25 patients reported a residual ability to walk alone or with help. Lower limb edema was present in 113 patients, bilateral in 41 cases. At admission all patients underwent extended compression ultrasonography. Their plasma D-dimer levels were measured. No antithrombotic prophylaxis was given.


RESULTS
DVT was found in 58 patients (43.9%); 32 had a history of VTE. Forty of these patients (69%) had chronic lower limb edema, in 19 cases bilateral. D-dimer levels in the DVT patients were significantly higher than in patients without DVT (553+/-678 vs. 261+/-152 ng/mL, p=0.0112, Mann-Whitney Test). Nearly half the DVT patients (26, 45%) had high D-dimer levels (701+/-684 ng/mL). Of the 74 patients without DVT, 48 had normal D-dimer (193.37+/-67.28 ng/mL) and 26 high (387.61+/-187.42 ng/mL).


CONCLUSIONS
The frequency of DVT in late-stage MS may be over 40%. The long history of the disease means the onset of each episode cannot be established with certainty. A number of patients with positive CUS findings had negative D-dimer values, suggesting a VTE event in the past. However, the level of DVT risk in this series should lead physicians to consider the systematic application of long-term preventive measures.
Arpaia
G
G
Vascular Medicine, Vimercate Hospital, Milan-Italy. guido.arpaia@tin.it
Bavera
P M
PM
Caputo
D
D
Mendozzi
L
L
Cavarretta
R
R
Agus
G B
GB
Milani
M
M
Ippolito
E
E
Cimminiello
C
C
D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism; D006801:Humans; D008297:Male; D009103:Multiple Sclerosis / Q000150:complications*; D011446:Prospective Studies; D012307:Risk Factors; D014463:Ultrasonography; D054556:Venous Thromboembolism; D020246:Venous Thrombosis / Q000097:blood* / Q000000981:diagnostic imaging / Q000209:etiology; D014910:Wheelchairs / Q000009:adverse effects*
D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D