The association between epilepsy and venous thromboembolism

Epilepsy spectrum disorders are associated with multiple cardiovascular and hematologic comorbidities, but the relationship with venous thromboembolism (VTE) remains understudied.1 Epilepsy has increasingly been conceptualized as a neuroinflammatory disorder with endothelial activation and blood-brain barrier disruption, which may promote systemic prothrombotic states via pro-inflammatory cytokines such as interleukin-1 (IL-1) and tumor necrosis factor-alpha (TNF-α). 2 Persons with epilepsy (PWE) also have increased thrombotic risk from immobility, obesity, hospitalization, and injury, yet also face elevated bleeding risk from trauma, medication-related coagulopathy, and hypoxia-related coagulation changes, complicating anticoagulation decisions.[2][3][4] To evaluate this relationship, we conducted a retrospective cohort study of adults (⩾ 18 years) at UVA Health between September 28, 2010, and March 12, 2024, using TriNetX, a de-identified aggregated electronic health record database.Patients with International Classification of Diseases, Tenth Revision (ICD-10) codes for malignancy, hypercoagulability states, Dravet syndrome (an intractable developmental and epileptic encephalopathy of infancy), or absence epilepsy were excluded.Epilepsy exposure was defined by ICD-10 code G40, and those without epilepsy served as controls.VTE included deep vein thrombosis (I82.4-I82.7),pulmonary embolism (I26, I27.82), and intracranial venous thrombosis (I67.6).To reduce reverse causation, VTE events were counted only if they occurred after the initial epilepsy code.Patients were stratified by sex and age group (18-34, 35-54, 55-64, ⩾ 65 years).Statistical analysis was conducted using SPSS Statistics 28.0.1 (IBM Corp.).Unadjusted differences in VTE prevalence between PWE and non-PWE were assessed using Pearson's χ 2 test.Stratified analyses by sex and age group were performed to evaluate the consistency of associations across subgroups.All cell counts exceeded five, supporting the use of χ 2 testing.Given that aggregated data without individual time-to-event and follow-up data precluded survivalThe association between epilepsy and venous thromboembolism