RT Journal Article
SR Electronic
T1 Increased Risk of Venous Thromboembolism in Patients With Amyotrophic Lateral Sclerosis
JF Neurology: Clinical Practice
FD Lippincott Williams & Wilkins
SP e200110
DO 10.1212/CPJ.0000000000200110
VO 13
IS 1
A1 Varant Kupelian
A1 Emma Viscidi
A1 Susan Hall
A1 Li Li
A1 Susan Eaton
A1 Anne Dilley
A1 Nicolas Currier
A1 Toby Ferguson
A1 Laura Fanning
YR 2023
UL http://cp.neurology.org/content/13/1/e200110.abstract
AB Background and Objectives Reduced mobility in patients with amyotrophic lateral sclerosis (ALS) is hypothesized to increase the risk of venous thromboembolism (VTE). A few small, single-center studies have investigated the risk of VTE in patients with ALS. Given the high morbidity and mortality associated with VTE, further understanding of the risk in patients with ALS may inform clinical care. The objective of this study was to investigate the incidence of VTE in patients with ALS compared with controls without ALS.Methods Patients were identified from a US health insurance claims database, Optum's deidentified Clinformatics Data Mart Database, between 2004 and 2019. ALS cases were defined as patients aged 18 years or older with (1) 2 or more ALS claims at least 27 days apart including at least 1 claim from a neurologist visit or (2) 1 or more ALS claims and a prescription for riluzole or edaravone. Each ALS case was matched on age and sex to 5 controls without ALS. VTE was defined as at least 1 claim for VTE and at least 1 anticoagulant prescription or VTE-related procedure within 7 days before and 30 days after a VTE claim date. Incidence rates were reported per 1,000 person-years. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using the Cox proportional hazards model.Results Among 4,205 ALS cases and 21,025 controls, incident VTE occurred in 132 ALS cases (3.1%) and 244 controls (1.2%). Incidence rates of VTE were 19.9 per 1,000 person-years (95% CI 16.7–23.6) in ALS cases compared with 6.0 per 1,000 person-years (95% CI 5.0–7.1) in controls. ALS cases were about 3 times more likely to develop VTE (HR 3.3, 95% CI 2.6–4.0), with similar results among men and women. The median time to first VTE was 10 months from the initial ALS claim in ALS cases.Discussion Consistent with previous smaller studies, a higher incidence rate of VTE was observed in a large sample of patients with ALS from across the United States, as compared to matched controls. The markedly increased risk underscores the importance of preventive efforts and careful monitoring for VTE in patients with ALS and may have implications for the management of ALS.