Big Data Institute, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.
J Neurol Neurosurg Psychiatry. 2024 Sep 17;95(10):912-918. doi: 10.1136/jnnp-2024-333399.
Venous thromboembolism (VTE) can occur in amyotrophic lateral sclerosis (ALS) and pulmonary embolism causes death in a minority of cases. The benefits of preventing VTE must be weighed against the risks. An accurate estimate of the incidence of VTE in ALS is crucial to assessing this balance.
This retrospective record-linkage cohort study derived data from the Hospital Episode Statistics database, covering admissions to England's hospitals from 1 April 2003 to 31 December 2019 and included 21 163 patients with ALS and 17 425 337 controls. Follow-up began at index admission and ended at VTE admission, death or 2 years (whichever came sooner). Adjusted HRs (aHRs) for VTE were calculated, controlling for confounders.
The incidence of VTE in the ALS cohort was 18.8/1000 person-years. The relative risk of VTE in ALS was significantly greater than in controls (aHR 2.7, 95% CI 2.4 to 3.0). The relative risk of VTE in patients with ALS under 65 years was five times higher than controls (aHR 5.34, 95% CI 4.6 to 6.2), and higher than that of patients over 65 years compared with controls (aHR 1.86, 95% CI 1.62 to 2.12).
Patients with ALS are at a higher risk of developing VTE, but this is similar in magnitude to that reported in other chronic neurological conditions associated with immobility, such as multiple sclerosis, which do not routinely receive VTE prophylaxis. Those with ALS below the median age of symptom onset have a notably higher relative risk. A reappraisal of the case for routine antithrombotic therapy in those diagnosed with ALS now requires a randomised controlled trial.
静脉血栓栓塞症（VTE）可发生在肌萎缩侧索硬化症（ALS）中，少数情况下肺栓塞可导致死亡。预防 VTE 的益处必须与风险相权衡。准确估计 ALS 中 VTE 的发生率对于评估这种平衡至关重要。
本回顾性记录链接队列研究从医院入院统计数据库中提取数据，涵盖了 2003 年 4 月 1 日至 2019 年 12 月 31 日期间英格兰医院的入院情况，包括 21163 名 ALS 患者和 17425337 名对照者。随访从索引入院开始，结束于 VTE 入院、死亡或 2 年（以先到者为准）。在控制混杂因素的情况下，计算 VTE 的调整后 HR（aHR）。
ALS 队列中 VTE 的发生率为 18.8/1000 人年。ALS 患者发生 VTE 的相对风险明显高于对照组（aHR 2.7，95%CI 2.4 至 3.0）。65 岁以下 ALS 患者发生 VTE 的相对风险是对照组的五倍（aHR 5.34，95%CI 4.6 至 6.2），高于 65 岁以上患者（aHR 1.86，95%CI 1.62 至 2.12）。
ALS 患者发生 VTE 的风险较高，但与其他与活动受限相关的慢性神经疾病（如多发性硬化症）的报告风险相当，这些疾病通常不接受 VTE 预防。发病中位年龄以下的 ALS 患者相对风险明显更高。现在需要进行一项随机对照试验，重新评估诊断为 ALS 的患者常规抗血栓治疗的必要性。
