{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,5]],"date-time":"2026-11-05T00:20:47Z","timestamp":1793838047547,"version":"4.6.1"},"reference-count":44,"publisher":"BMJ","license":[{"start":{"date-parts":[[2024,3,28]],"date-time":"2024-03-28T00:00:00Z","timestamp":1711584000000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["J Neurol Neurosurg Psychiatry"],"accepted":{"date-parts":[[2024,3,4]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This retrospective record-linkage cohort study derived data from the Hospital Episode Statistics database, covering admissions to England\u2019s hospitals from 1 April 2003 to 31 December 2019 and included 21\u2009163 patients with ALS and 17\u2009425\u2009337 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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>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%\u2009CI 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%\u2009CI 4.6 to 6.2), and higher than that of patients over 65 years compared with controls (aHR 1.86, 95%\u2009CI 1.62 to 2.12).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec>","DOI":"10.1136\/jnnp-2024-333399","type":"journal-article","created":{"date-parts":[[2024,3,28]],"date-time":"2024-03-28T17:29:08Z","timestamp":1711646948000},"page":"jnnp-2024-333399","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Venous thromboembolism risk in amyotrophic lateral sclerosis: a hospital record-linkage study"],"prefix":"10.1136","author":[{"given":"Raph","family":"Goldacre","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4848-6156","authenticated-orcid":false,"given":"Michael","family":"Trubshaw","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eva J A","family":"Morris","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5490-1697","authenticated-orcid":false,"given":"Kevin","family":"Talbot","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael J","family":"Goldacre","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1063-3277","authenticated-orcid":false,"given":"Alexander Guy","family":"Thompson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0267-3180","authenticated-orcid":false,"given":"Martin R","family":"Turner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2024,3,28]]},"reference":[{"key":"2024032810252256000_jnnp-2024-333399v1.1","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1080\/17482960701656940","article-title":"Causes of death in a post\u2010mortem series of ALS patients","volume":"9","author":"Corcia","year":"2008","journal-title":"Amyotroph Lateral Scler"},{"key":"2024032810252256000_jnnp-2024-333399v1.2","doi-asserted-by":"publisher","DOI":"10.1177\/1358863X14568706"},{"key":"2024032810252256000_jnnp-2024-333399v1.3","doi-asserted-by":"crossref","first-page":"1674","DOI":"10.1212\/WNL.0000000000000405","article-title":"Venous thromboembolism in amyotrophic lateral sclerosis","volume":"82","author":"Gladman","year":"2014","journal-title":"Neurology"},{"key":"2024032810252256000_jnnp-2024-333399v1.4","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.114.009107"},{"key":"2024032810252256000_jnnp-2024-333399v1.5","doi-asserted-by":"publisher","DOI":"10.1016\/j.thromres.2010.03.016"},{"key":"2024032810252256000_jnnp-2024-333399v1.6","doi-asserted-by":"publisher","DOI":"10.1016\/0049-3848(94)90100-7"},{"key":"2024032810252256000_jnnp-2024-333399v1.7","doi-asserted-by":"crossref","first-page":"1309","DOI":"10.1016\/S0140-6736(60)92299-6","article-title":"Anticoagulant drugs in the treatment of pulmonary embolism - A controlled trial","volume":"275","author":"Barritt","year":"1960","journal-title":"Lancet"},{"key":"2024032810252256000_jnnp-2024-333399v1.8","doi-asserted-by":"crossref","DOI":"10.1183\/13993003.00275-2017","article-title":"Management of incidental pulmonary embolism","volume":"49","author":"Klok","year":"2017","journal-title":"Eur Respir J"},{"key":"2024032810252256000_jnnp-2024-333399v1.9","doi-asserted-by":"crossref","first-page":"122896","DOI":"10.1016\/j.jns.2024.122896","article-title":"Deep vein thrombosis and its risk factors in neurodegenerative diseases: a markedly higher incidence in Parkinson\u2019s disease","volume":"457","author":"Takeda","year":"2024","journal-title":"J Neurol Sci"},{"key":"2024032810252256000_jnnp-2024-333399v1.10","doi-asserted-by":"publisher","DOI":"10.1002\/art.22663"},{"key":"2024032810252256000_jnnp-2024-333399v1.11","doi-asserted-by":"publisher","DOI":"10.1378\/chest.11-2296"},{"key":"2024032810252256000_jnnp-2024-333399v1.12","doi-asserted-by":"crossref","first-page":"1122","DOI":"10.1001\/jamainternmed.2018.2022","article-title":"Use of venous thromboembolism prophylaxis in hospitalized patients","volume":"178","author":"Grant","year":"2018","journal-title":"JAMA Intern Med"},{"key":"2024032810252256000_jnnp-2024-333399v1.13","unstructured":"NICE . 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