MS May Raise Risk of Deep-vein Blood Clots, Possibly by Limiting Mobility, Study Says

MS May Raise Risk of Deep-vein Blood Clots, Possibly by Limiting Mobility, Study Says

People with multiple sclerosis may be twice as likely to develop deep-vein blood clots, a condition known as venous thromboembolism, than healthy people do, a study reports.

But data linking the two is limited, and its researchers say further work is needed to understand if MS is directly related to venous thromboembolism, or if this condition is a secondary effect of limited mobility.

The review article, “Multiple sclerosis and the risk of systemic venous thrombosis: A systematic review,” was published in the journal Multiple Sclerosis and Related Disorders.

A loss of flexibility and range of movement in the body or joints — called hypomobility — is a known risk factor for venous thromboembolism. In this condition, blood clots form commonly in the deep veins of the leg, groin, or arm, and travel in circulating blood to lodge in the lungs.

Certain neurological diseases are associated with partial paralysis and venous thromboembolism, including spinal injury and stroke.

Research into the incidence of venous thromboembolism in MS patients has only skimmed the surface. MS has a range of clinical features, such as disease type, duration, and severity, that could be associated with a higher risk of venous thromboembolism.

Researchers at Oxford University Hospitals and the Royal Berkshire NHS Foundation Trust examined how often venous thromboembolism occurred in MS patients. To do so, they compiled clinical data going back to the 1950s, and compared MS patients with healthy individuals.

Their literature review found 10 MS studies looking at the risk of venous thromboembolism. Of these, six studies involved large cohorts — more than 1,000 patients in each — and were included in the analysis.

Results showed that, on average, MS patients had a 1.91 times increased risk of a venous thromboembolism compared those without this disease. But this was not an entirely consistent result, with one study reporting that MS had a protective effect  and lowered risk.

Disease severity, as defined by number and length of MS-related hospitalizations and need for walking aids, seemed to be the only factor predictive of venous thromboembolism.

But most of the studies did not characterize MS groups well enough for the researchers to make further conclusions. They could not examine if the MS type, disease duration, and treatment were associated with a higher venous thromboembolism risk.

Importantly, researchers were unable to determine if MS itself increases the risk of venous thromboembolism , or if secondary complications, such as hypomobility, are responsible.

“Immobility associated with severe disease is an obvious risk factor but MS has also been linked to elevated markers of endothelial damage and activation of the coagulation pathway,” the researchers wrote. “The increased risk of venous thromboembolism in MS patients could, therefore, be due not only to immobility but systemic autoimmune mechanisms increasing thrombotic risk.”

Curiously, researchers found that steroids and anti-depressants were linked to an increased venous thromboembolism risk. Steroids and antidepressants have been linked to venous thromboembolism in the general population and in specific diseases; however, these may be markers of disease severity and this link could simply be a byproduct of some other effect.

Overall, the team concluded that MS patients are at increased risk of developing venous thromboembolism, and suggest that “there may be a role for VTE [venous thromboembolism] prophylaxis in high risk patients.”

“More detailed data sources are needed to recognize specific MS-related risk factors and just how much risk they present,” the researchers added. “This important data would have direct clinical relevance in risk stratification for potential venous thromboembolism prophylaxis.”

2 comments

  1. Father Glen Gleaves says:

    I’ve had primary-progressive multiple sclerosis since 1986, and started having DVTs in 1992. So far,
    I’ve had 4; and one, which my hospital’s ultrasonographer missed (“Good news! You don’t have a DVT.) dislodged the next day and became a PE, causing me to lose 30% of my lung function.

    In those days I was having to have 10-day in-patient corticosteroid IV therapy up to 4x/year (ACTH in the early days, then later, shorter methylprednisolone series, plus monthly “pulse therapy”). However, because I also had chronic optic neuritis and severe optic nerve pain, my docs had me on 1,000 mg/day of carbamazepine to ameliorate the pain. That’s when I started getting the DVTs –but my docs NEVER picked up on the fact that this is a known synergistic drug combination and recipe for DVTs.

    I discovered the danger of this drug combination via internet searches and brought the info to my docs, who had an “aha!” moment (my docs welcome me as part of the healing team). Later, my internist discovered that I also had hyperhomocysteinemia –a condition that causes clots when either vitamin B-12 or folate –or both– drops too low. I was deficient in both. So now, I’m on warfarin, B-12 and folic acid, as preventative measures, and off of the carbamazepine. After 33 years of PPMS, my 15 med chemical soup, including miracle drugs dalfampridine and Ocrevus, lots of physical therapy and pushing myself to maintain an active lifestyle, the power chair is history, and forearm crutches keep me mobile, with only an occasional use of my manual chair.

    In 1935 DuPont coined the advertising phrase that sums up my life: “Better Living….Through Chemistry.” And… NO MORE DVTs!! With astute, caring doctors over the years (I’ve fired many, hired more), who have listened, observed, studied, cared and worked hard with me to thread our way through this complicate PPMS jungle (add including psoriasis & psoriatic arthritis to the mix), all I can say is, “Life’s good!”

    So, are DVTs more common with MS? I’m certain that a more sedentary life can bring them on. But so can med combinations. Both are avoidable with care. You DON’T want DVTs to further complicate your life!

  2. Jay Blake says:

    I probably don’t even belong here, because my MS is incredibly mild (knock on wood) and I run 4 – 6 miles 4 days a week, BUT I also had a DVT a couple years ago. After reading this article, it makes me wonder if my MS had anything to do with it. But it sure wasn’t from hypomobility!

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