Deep Vein Thrombosis in Patients with Severe Motor and Intellectual Disabilities, Especially Diagnosis and Prevention of Recurrence for Chronic Thrombosis—Serial Changes of Sonography and D-Dimer

Abstract

This article is a translation of Jpn J Phlebol 2014; 25: 34-42. Most patients with severe motor and intellectual disabilities (SMID) have restricted mobility capability and have been bedridden for long periods because of paralysis of the extremities caused by abnormal muscular tonicity due to cerebral palsy and developmental disabilities. Such patients are associated with a high risk of complications like deep vein thrombosis (DVT). Here, we report twelve patients (42.9%) with DVT among 28 patients with SMID during prolonged bed rest. However, we did not detect thrombosis in the soleal veins, finding it mostly in the femoral and common femoral veins. We applied anticoagulant therapy (warfarin), and carefully followed up the cases with DVT, regulating the warfarin dosage at prothrombin time-international normalized ratio (PT-INR) values around two to prevent recurrence of chronic thrombosis. Regarding laboratory data for the coagulation system, there were no cases above 5 µg/ml for the D-dimer and there were significant differences between the DVT and non-DVT groups in the D-dimer levels. The plasma levels of D-dimer in patients with DVT diminished to less than 1.0 µg/ml after warfarin treatment. Concerning sudden death (4.2%) in patients with SMID, we have to be very careful of the possibility of pulmonary thromboembolism due to DVT. Therefore, we should consider the particularity of the underdeveloped vascular system from underlying diseases for the evaluation of DVT. A detailed study of DVT as a vascular complication is very important for the smooth medical care of SMID, and serial assessment of compression Doppler ultrasonography of the lower extremities, as a noninvasive examination and measurement of D-dimer, is very helpful. (This article is a translation of Jpn J Phlebol 2014; 25: 34-42.)

Quantitative Sonographic Assessment of the Quadriceps Femoris Muscle in Healthy Japanese Adults

“…Furthermore, it is well known that disuse syndrome is developed by a sedentary lifestyle, which is shown by several symptoms, such as muscular deconditioning and atrophy resulting from inactivity or immobilization. In patients with severe motor and intellectual disabilities who are confined to bed and with decreased mobility of the lower extremities, there is a higher risk of the complication of deep venous thrombosis (DVT) . This condition can have an asymptomatic clinical course, but some cases of DVT develop pulmonary thromboembolism, possibly causing sudden death .…”

“…In patients with severe motor and intellectual disabilities who are confined to bed and with decreased mobility of the lower extremities, there is a higher risk of the complication of deep venous thrombosis (DVT). 31 This condition can have an asymptomatic clinical course, but some cases of DVT develop pulmonary thromboembolism, possibly causing sudden death. 32 The data in this study demonstrate that the proposed index correlated significantly with muscle strength.…”

Deep Vein Thrombosis in Severe Motor and Intellectual Disabilities Patients and Its Treatment by Anticoagulants of Warfarin Versus Edoxaban

“…[2][3][4][5][6] Although the incidence of DVT is high in SMID patients, [3][4][5][6] current DVT-PTE guidelines 4) are targeted toward adults who can walk, not those with poor mobility who are often bedridden due to muscle tension abnormalities resulting from cerebral palsy and developmental movement disorders from early childhood. 1,[3][4][5][6] Although the DVT-PTE guidelines recommend administration of the oral anticoagulant warfarin, strict dose control, based on the international normalized ratio of the prothrombin time (PT-INR), is needed to ensure adequate efficacy and prevent bleeding complications. 4) Evaluations of time in the therapeutic range (TTR) have been proposed as an index to assess whether dose control is good or bad, which is important for maintaining TTR.…”

Comparison of the Precision of Compression Ultrasonography and Duplex Sonography in Deep Venous Thrombosis Patients

“…Sonography as the golden standard now is less used for DVT diagnosis, and it has more surgical applications (van der Graaf et al, 2000). Intravenous sonography needs the patient to be transferred to the radiology department, and must be done by a radiologist (Chung, Luk, Lo, & Lo, 2015;Goldhaber & Bounameaux, 2012;Ohmori et al, 2015). Thus, it incurs more time and cost to the patient and on the other hand, due to social and economic situations, residing a radiologist for 24 hours in the hospitals is impossible, and the shortage of skilled manpower is seen more in less developed areas and in remote cities.…”