Venous Thromboembolism in Patients with Motor Neuron Disease – Are We Undercounting?

Pyarali FF, Allen S, Frank S, Tamondong R and Elsayegh A

Published on: 2023-11-20

Abstract

Introduction

Venous thromboembolism (VTE) in patients with motor neuron disease (MND) is a known complication, though the overall incidence and associated risk factors are less clear. We analyzed the incidence of VTE in a cohort of patients with MND in a single center.

Methods

541 patients with a diagnosis of amyotrophic lateral sclerosis (ALS), primary lateral sclerosis (PLS) or other adult MND, were reviewed. The primary outcome measure was symptomatic VTE (pulmonary embolism, deep venous thrombosis or both), at or after onset of symptoms related to their MND diagnosis.

Results

The overall incidence of VTE in patients with MND was 9.6% (52/541 patients). Of the 52 patients who were identified as having VTE, 75% (39 patients) were diagnosed with only DVT, 17% with DVT and PE, and 7% with solely PE (4 patients). The incidence of VTE was higher among patients with PLS compared to those without PLS (31% PLS vs. 9.1% non-PLS, p=0.01).

Conclusion

The incidence of VTE in MND in our patient cohort was notable and higher than the noted risk of VTE in the general elderly population. The incidence was higher among the subset of patients with PLS. These results may be under-represented due to decrease in clinic visits towards the end of life, shortness of breath being attributed to diaphragmatic weakness, and fewer diagnostic tests performed towards the end of life. Future studies identifying high-risk patients within this population could lead to earlier detection, prevention and treatment of VTE in patients with MND and improve quality of life.