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MS research update - Increased risk of lodged blood clots in the bloodstream: VTE (venous thromboembolism) in people with MS - 10 February 2014

Summary

Venous thromboembolism (VTE) is when part of a blood clot breaks off, gets carried round the bloodstream and lodges in a blood vessel causing a blockage. This might be in the lungs, where it is called a pulmonary embolism, or in a vein lying deep below the skin, especially in the legs, where it is called deep vein thrombosis (DVT).

5,566 people with MS were followed alongside 33,370 people who did not have a diagnosis of MS at the start of the study.

The researchers found that people with MS had a more than two fold (2.6 times) increased risk of VTE. Venous thromboembolism (VTE) was more likely if the person had experienced one before, had varicose veins, was obese or had experienced major trauma. In addition, there was greater risk for people with MS who experienced spasticity, had difficulty moving around, had disability or took glucocorticoids (steroids that include prednisone, dexamethasone, and hydrocortisone).

Changes in lifestyle can reduce the risk of VTE and there are simple steps you can take, for example, when taking long journeys.

Background

Venous thromboembolism (VTE) is when part of a blood clot breaks off, gets carried round the bloodstream and lodges in a blood vessel causing a blockage. This might be in the lungs, where it is called a pulmonary embolism, or in a vein lying deep below the skin, especially in the legs, where it is called deep vein thrombosis (DVT). DVT has been in the news recently because of the increased risk of DVT during air travel when someone is sitting for long periods of time. There is also an increased risk for people who are unable to move around much due to ill health.

How this study was carried out

5,566 people with MS were followed alongside 33,370 people who did not have a diagnosis of MS at the start of the study. Each person with MS was matched to six of the controls by sex, year of birth and the practice where they received their healthcare.

Each participant was followed until they either experienced their first venous thromboembolism (VTE), moved away, died or the study ended, whichever happened first.

The data was analysed to work out the risk of someone with MS having a VTE compared with the controls who did not have MS. The data was also analysed to determine what the specific risk factors might be for people with MS. Allowances were made for age, any other medical conditions that someone had (comorbidities) and the medications they were taking as these could independently increase someone's risk of VTE.

What was found

The researchers found that people with MS had a more than two fold (2.6 times) increased risk of VTE. Venous thromboembolism (VTE) was more likely if the person had experienced one before, had varicose veins, was obese or had experienced major trauma. In addition, there was greater risk for people with MS who experienced spasticity, had difficulty moving around, had disability or took glucocorticoids (steroids that include prednisolone, dexamethasone, and hydrocortisone)

What does it mean?

This research shows that people with MS are more at risk than the general population of getting VTE. This is due, at least in part, to some of the risk factors for VTE being more common in people with MS.

Peeters PJ, Bazelier MT, Uitdehaag BM, et al.
The Risk of Venous Thromboembolism in Patients with Multiple Sclerosis: The Clinical Practice Research Datalink. .
J Thromb Haemost. 2014 Feb 6. [Epub ahead of print]
abstract

More about reducing the risk of VTE (venous thromboembolism)

You can read general information about blood clots and venous thromboembolism (VTE) on the NHS Choices website. This section is particularly useful if you are going into hospital for an operation as there is an increased risk of VTE.

VTE can be divided into deep vein thrombosis (DVT) and pulmonary embolism.

In some cases of deep vein thrombosis (DVT) there may be no symptoms, but possible symptoms of DVT include:

  • pain, swelling and tenderness in one of your legs (usually your calf)
  • a heavy ache in the affected area
  • warm skin in the area of the clot
  • redness of your skin, particularly at the back of your leg, below the knee

It can be difficult to recognise the signs and symptoms of a pulmonary embolism because they can vary between individuals. Small clots may cause no noticeable symptoms.

Symptoms of a pulmonary embolism can include:

  • chest or upper back pain – a sharp, stabbing pain that may be worse when breathing in
  • shortness of breath – which may come on suddenly or develop gradually
  • coughing – which is usually dry, but may include coughing up blood or mucus that contains blood
  • feeling light-headed or dizzy
  • fainting

Reducing your risk of VTE

You can reduce your risk of VTE by making changes to your lifestyle, such as:

  • not smoking
  • eating a healthy balanced diet
  • getting regular exercise if possible. Walking to improve the circulation in the legs is good.
  • maintaining a healthy weight or losing weight if you are overweight or obese

If you are travelling and at risk of getting a VTE, or have had a VTE previously, consult your GP or MS nurse before undertaking a long journey. For journeys of six hours or more, ensure that you:

  • drink plenty of water
  • avoid excessive alcohol as it can lead to dehydration
  • avoid taking sleeping pills as it can cause immobility
  • perform simple leg exercises, such as regularly flexing your ankles
  • take occasional short walks when possible
  • wear elastic compression stockings

Research by topic areas...

Diagnosis

Solari A.
Effective communication at the point of multiple sclerosis diagnosis.
Mult Scler. 2014 Feb 6. [Epub ahead of print]
abstract

Noyes K, Weinstock-Guttman B.
Impact of diagnosis and early treatment on the course of multiple sclerosis.
Am J Manag Care. 2013 Nov;19(17 Suppl):s321-31.
abstract
Read the full text of this paper

Symptoms and symptom management

Di Filippo M, Proietti S, Gaetani L, et al.
Lower urinary tract symptoms and urodynamic dysfunction in clinically isolated syndromes suggestive of multiple sclerosis.
Eur J Neurol. 2014 Jan 28. [Epub ahead of print]
abstract

Disease modifying treatments

Prosperini L, Mancinelli CR, Pozzilli C, et al.
From High- to Low-Frequency Administered Interferon-Beta for Multiple Sclerosis: A Multicenter Study.
Eur Neurol. 2014 Jan 25;71(5-6):135-143. [Epub ahead of print]
abstract

Confavreux C, O'Connor P, Comi G, et al.
Oral teriflunomide for patients with relapsing multiple sclerosis (TOWER): a randomised, double-blind, placebo-controlled, phase 3 trial.
ancet Neurol. 2014 Jan 22. pii: S1474-4422(13)70308-9.[Epub ahead of print]
abstract

Xiao Y, Huang J, Luo H, Wang J.
Mycophenolate mofetil for relapsing-remitting multiple sclerosis.
Cochrane Database Syst Rev. 2014 Feb 7;2:CD010242. [Epub ahead of print]
abstract
Read the full text of this paper

Kamm CP, El-Koussy M, Humpert S, et al.
Atorvastatin Added to Interferon Beta for Relapsing Multiple Sclerosis: 12-Month Treatment Extension of the Randomized Multicenter SWABIMS Trial.
PLoS One. 2014 Jan 30;9(1):e86663.
abstract
Read the full text of this paper

Weinstock-Guttman B.
An update on new and emerging therapies for relapsing-remitting multiple sclerosis.
Am J Manag Care. 2013 Nov;19(17 Suppl):s343-54
abstract
Read the full text of this paper

Happe LE.
Choosing the best treatment for multiple sclerosis: comparative effectiveness, safety, and other factors involved in disease-modifying therapy choice.
Am J Manag Care. 2013 Nov;19(17 Suppl):s332-42.
abstract
Read the full text of this paper

Perrin Ross A.
Management of multiple sclerosis.
Am J Manag Care. 2013 Nov;19(16 Suppl):s301-6.
abstract
Read the full text of this paper

Wingerchuk DM, Carter JL.
Multiple sclerosis: current and emerging disease-modifying therapies and treatment strategies.
Mayo Clin Proc. 2014 Feb;89(2):225-40.
abstract

Saiz A, Mora S, Blanco J, et al.
Therapeutic compliance of first line disease-modifying therapies in patients with multiple sclerosis.
2014 Jan 28. pii: S0213-4853(13)00294-6.[Epub ahead of print]
abstract

Olival GS, Cavenaghi VB, Serafim V,, et al.
Medication withdrawal may be an option for a select group of patients in relapsing-remitting multiple sclerosis.
Arq Neuropsiquiatr. 2013 Aug;71(8):516-20.
abstract
Read the full text of this paper

Drugs in development

Leist TP, Comi G, Cree BA, et al.
Effect of oral cladribine on time to conversion to clinically definite multiple sclerosis in patients with a first demyelinating event (ORACLE MS): a phase 3 randomised trial.
Lancet Neurol. 2014 Feb 3. [Epub ahead of print]
abstract

Other treatments

Bisht B, Darling WG, Grossmann RE, et al.
A Multimodal Intervention for Patients with Secondary Progressive Multiple Sclerosis: Feasibility and Effect on Fatigue.
J Altern Complement Med. 2014 Jan 29. [Epub ahead of print]
abstract

Co-existing conditions

Magyari M, Koch-Henriksen N, Pfleger CC, et al.
Gender and autoimmune comorbidity in multiple sclerosis.
Mult Scler. 2014 Feb 5. [Epub ahead of print]
abstract

Oliveira SR, Colado Simão AN, Kallaur AP, et al.
Disability in patients with multiple sclerosis: Influence of insulin resistance, adiposity, and oxidative stress.
Nutrition. 2014 Mar;30(3):268-73.
abstract

Assessment tools

Allali G, Laidet M, Assal F, et al.
Dual-Task Assessment in Natalizumab-Treated Multiple Sclerosis Patients.
Eur Neurol. 2014 Feb 1;71(5-6):149-153. [Epub ahead of print]
abstract

Baert I, Freeman J, Smedal T, et al.
Responsiveness and Clinically Meaningful Improvement, According to Disability Level, of Five Walking Measures After Rehabilitation in Multiple Sclerosis: A European Multicenter Study.
Neurorehabil Neural Repair. 2014 Feb 6. [Epub ahead of print]
abstract

Quality of life

Chruzander C, Ytterberg C, Gottberg K, et al.
A 10-year follow-up of a population-based study of people with multiple sclerosis in Stockholm, Sweden: Changes in health-related quality of life and the value of different factors in predicting health-related quality of life.
J Neurol Sci. 2014 Jan 23. [Epub ahead of print]
abstract

Causes of MS

Marrie RA, Beck CA.
Obesity and HLA in multiple sclerosis: Weighty matters.
Neurology. 2014 Feb 5. [Epub ahead of print]
abstract

Vitamin D

Golan D, Staun-Ram E, Glass-Marmor L, et al.
The influence of vitamin D supplementation on melatonin status in patients with multiple sclerosis.
Brain Behav Immun. 2013 Aug;32:180-5.
abstract

Hewer S, Lucas R, van der Mei I, et al.
Vitamin D and multiple sclerosis.
J Clin Neurosci. 2013 May;20(5):634-41.
abstract

Paediatric MS

Reinhardt K, Weiss S, Rosenbauer J, et al.
Multiple sclerosis in children and adolescents: incidence and clinical picture - new insights from the nationwide German surveillance (2009-2011).
Eur J Neurol. 2014 Jan 28. [Epub ahead of print]
abstract

Tenembaum SN, Banwell B, Pohl D, et al.
Subcutaneous interferon Beta-1a in pediatric multiple sclerosis: a retrospective study.
J Child Neurol. 2013 Jul;28(7):849-56.
abstract

Psychological aspects

Fragoso YD, Adoni T, Anacleto A, et al.
Recommendations on diagnosis and treatment of depression in patients with multiple sclerosis.
Pract Neurol. 2014 Feb 5. [Epub ahead of print]
abstract

Pakenham KI, Cox S.
Comparisons between youth of a parent with MS and a control group on adjustment, caregiving, attachment and family functioning.
Psychol Health. 2013 Jan;29(1):1-15.
abstract

Physical activity

Medina-Perez C, de Souza-Teixeira F, Fernandez-Gonzalo R, et al.
Effects of a resistance training program and subsequent detraining on muscle strength and muscle power in multiple sclerosis patients.
NeuroRehabilitation. 2014 Jan 24. [Epub ahead of print]
abstract

Allali G, Laidet M, Assal F, et al.
Walking while talking in patients with multiple sclerosis: The impact of specific cognitive loads.
Neurophysiol Clin. 2014 Jan;44(1):87-93.
abstract

Economics

Darbà J, Kaskens L, Sánchez-de la Rosa R.
Cost-Effectiveness of Glatiramer Acetate and Interferon beta-1a for Relapsing-Remitting Multiple Sclerosis, based on the CombiRx Study.
J Med Econ. 2014 Feb 5. [Epub ahead of print]
abstract

Prognosis

Sand IK, Krieger S, Farrell C, et al.
Diagnostic uncertainty during the transition to secondary progressive multiple sclerosis.
Mult Scler. 2014 Feb 3. [Epub ahead of print]
abstract

Pathophysiology

Ginsberg D.
The epidemiology and pathophysiology of neurogenic bladder.
Am J Manag Care. 2013 Jul;19(10 Suppl):s191-6.
abstract
Read the full text of this paper

Provision of care

Noyes K, Bajorska A, Wasserman EB, et al.
Transitions between SNF and home-based care in patients with multiple sclerosis.
NeuroRehabilitation. 2014 Jan 24. [Epub ahead of print]
abstract

Owens GM.
Managed care aspects of managing multiple sclerosis.
Am J Manag Care. 2013 Nov;19(16 Suppl):s307-12.
abstract
Read the full text of this paper

Pregnancy and childbirth

Karlsson G, Francis G, Koren G, et al.
Pregnancy outcomes in the clinical development program of fingolimod in multiple sclerosis.
Neurology. 2014 Jan 24. [Epub ahead of print]
abstract

Lu E, Zhu F, Zhao Y, et al.
Birth outcomes of pregnancies fathered by men with multiple sclerosis.
Mult Scler. 2014 Feb 5. [Epub ahead of print]
abstract

Morgan-Followell BN, Nicholas JA, Weisleder P.
Reproductive issues in women with multiple sclerosis: ethical considerations.
Continuum (Minneap Minn). 2014 Feb;20(1 Neurology of Pregnancy):177-80.
abstract

Coyle PK.
Multiple sclerosis in pregnancy.
Continuum (Minneap Minn). 2014 Feb;20(1 Neurology of Pregnancy):42-59.
abstract

Fragoso YD, Fragoso SD, Finkelsztejn A, et al.
Systematic review versus internet search: considerations about availability and reliability of medical information regarding pregnancy in women with multiple sclerosis.
Rev Bras Epidemiol. 2012 Dec;15(4):896-903.
abstract
Read the full text of this paper

Stem cells

Ardeshiry Lajimi A, Hagh MF, Saki N, et al.
Feasibility of Cell Therapy in Multiple Sclerosis: A Systematic Review of 83 Studies.
Int J Hematol Oncol Stem Cell Res. 2013;7(1):15-33. Review.
abstract
Read the full text of this paper

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