Postural Abnormality as a Risk Marker for Leg Deep Venous Thrombosis in Parkinson’s Disease

Abstract

BackgroundPulmonary thromboembolism is a common cause of death in patients with autopsy-confirmed Parkinsonism. This study investigated the incidence of leg deep vein thrombosis in Parkinson’s disease and relationships between deep vein thrombosis and clinical/laboratory findings, including postural abnormalities as assessed by photographic measurements.MethodsThis cross-sectional study assessed the presence of deep vein thrombosis using bilateral leg Doppler ultrasonography in 114 asymptomatic outpatients with Parkinson’s disease.ResultsDeep vein thrombosis was detected in 23 patients (20%) with Parkinson’s disease. Deep vein thrombosis was located in the distal portion in 18 patients and in the proximal portion in 5 patients. No significant differences in age, sex, body mass index, disease duration, Hoehn-Yahr stage, anti-Parkinson’s drugs, or daily levodopa-equivalent dose were seen between deep vein thrombosis-positive and -negative groups. Univariate analysis for developing deep vein thrombosis in patients with Parkinson’s disease identified the following markers: long-term wheelchair use, bent knee, bent spine, and D-dimer elevation. Bending angles were significantly greater in the deep vein thrombosis-positive group at the knee and spine than in the deep vein thrombosis-negative group. Half of Parkinson’s disease patients with camptocormia had deep vein thrombosis. Among diabetes mellitus cases, long-term wheelchair use, bent knee over 15°, camptocormia, D-dimer elevation, the more risk markers were associated with a higher incidence of DVT. The presence of risk markers contributed to the development of deep vein thrombosis. On multivariate logistic regression analysis, a bent knee posture was strongly associated with an increased risk of deep vein thrombosis.ConclusionPresence of leg deep vein thrombosis correlated with postural abnormalities in Parkinson’s disease. We recommend non-invasive ultrasonographic screening for leg deep vein thrombosis in these high-risk patients with Parkinson’s disease.

Postural deformities in Parkinson’s disease –Mutual relationships among neck flexion, fore-bent, knee-bent and lateral-bent angles and correlations with clinical predictors

“…Seki et al reported that FB may cause severe constipation and urinary frequency [ 10 ]. A recent study by Yamane et al [ 17 ] showed that PD patients with FB and KB frequently have deep venous thrombosis of their lower extremities. With LB, patient can develop lumbar pain, dyspnea, unsteadiness leading to falls, or lower leg numbness due to radiculopathy.…”

Camptocormia in Parkinson's disease: definition, epidemiology, pathogenesis and treatment modalities

“…Camptocormia produces many negative consequences such as self-embarrassment or postural instability, whereas respiratory compromise is still controversial. 66 A recent study conducted by Yamane et al 67 showed that patients with PD with camptocormia frequently have deep venous thrombosis of their lower extremities when compared with PD without camptocormia (17% vs 4%, respectively).…”

Unprovoked Saddle Pulmonary Embolism in a Patient with Shy-Drager syndrome. Are They Related?

“…DVTs were noted in 20% of the patients with significantly increased knee and spine bending angles. In conclusion the study indicated that Parkinson's patients have decreased mobility due to motor abnormalities, which leads to an increased risk of thrombosis [9]. In patients with Shy-Drager syndrome, in addition to decreased mobility from Parkinsonism features, another feature which might contribute to venous thromboembolism is the presence of orthostatic hypotension, which can lead to pooling and stasis of the blood in the lower extremities, thereby increasing the risk of thrombosis.…”