Risk of deep venous thrombosis (DVT) in bedridden or wheelchair-bound multiple sclerosis patients : a prospective study

Thrombotic risk and its prophylaxis during hospitalization for acute diseases are well known. Less is known about the persistence of the risk during the chronic phase of the disease when it causes the patient to live ina prolonged state of hypo/immobility at home or to be taken into an skilled nursing home (NH). We conducted a compression ultrasound (CUS) scan on patients suffering hypomobility due to neurological disease or the invalidating consequences of chronic diseases, assisted at home (HC), in an NH or at a rehabilitation centre (RC). We studied a total of 422 patients, 201 of whom suffering from Multiple Sclerosis (MS). The remaining 221 were assisted by HC services or taken into an NH. Peripheral oedema was observed in 70 % of cases. Forty-four per cent of the patients with MS presented signs of recent or past VT. Seventy per cent suffered from peripheral oedema. The presence of oedema, D-dimer levels and a positive medicai history of venous thrombosis (VT) are the most significant risk factors. In the group cared for at home or in an NH, the prevalence was 18 %. The time that had passed since the acute disease, admission to an NH, a medicai history of VT and cognitive impairment were found to be correlated with the highest risk. One hundred and two patients with MS wore ATE stockings during the rehabilitation period. Peripheral oedema was more frequent (80 % vs. 40 %) and the D-Dimer level was higher (471 mg/dl vs. 271 mg/dl) than in the controls. The oedema subsided completely and the D-Dimer levels decreased to a greater degree(-24 % vs. -7 %). No episodes of DVT occurred in either of the groups. The onset of VT in our group of patients cannot be dated with certainty. Prolonged prophylaxis with ATE could combat the onset of peripheral oedema caused by inactivity and reduce thrombotic risk in these categories of patients.