Prevalence and Characteristic Features of Deep Venous Thrombosis in Patients with Severe Motor and Intellectual Disabilities

Abstract

Sudden death associated with patients with severe motor and intellectual disabilities (SMID) have been thought to be caused in part by venous thromboembolism (VTE), but actual situation of VTE in SMID is not clear. We examined the prevalence and location of deep venous thrombosis (DVT), and the relation of the development of crural veins in 16 patients with SMID, using ultrasonography. The maximum diameter of soleal vein was 1.6±0.5 mm. In most cases, DVT was found in the femoral veins. We could not detect thrombus in the soleal veins. In the present study, the detection ratio of DVT was high in patients with SMID who had restricted mobility capability and were bedridden, and we found the veins centrally from popliteal veins in DVT in SMID, not soleal veins, as the initial sites of the DVT. In the literature, the mean diameter of soleal veins, in healthy adults is 6.7±1.8 mm, that in contrast in SMID being smaller. Underdevelopment of intramuscular veins is possibly related to the mechanism of DVT in SMID. In the current guidelines for the management of VTE, there is limited in scope of ambulatory adults and no application cases who exhibit to SMID restricted mobility of the lower extremities and are bedridden associated with cerebral palsy and developmental motor disabilities, and such patients have associated high risk of the complications of DVT. According to our present study, it is necessary to provide appropriate guidelines for DVT in SMID considering characteristic features. (This is a translation of Jpn J Phlebol 2017; 28: 29–34.)

Multisystem inflammatory syndrome in children and SARS-CoV-2: A scoping review

“…In addition to potentially masking the clinical symptoms of MIS-C, conditions in patients with severe motor and intellectual disabilities (SMID) may have elevated laboratory findings. Lower extremity deep vein thromboses, for example, have been found to cause asymptomatic elevated D-dimer findings in patients with SMID [81,82]. In addition to laboratory findings secondary to prolonged rest, decreased exercise as a result of the COVID-19 pandemic may cause worsening musculoskeletal function and subsequent decline in physical ability -presenting yet another long-term challenge to the physiatrist and other members of the rehabilitation care team.…”

Venous Thromboembolism among Critically Ill Children: A Narrative Review

“…In adult literature, cumulative incidence of DVT among patients with severe motor and intellectual disability may be as high as 8.4% and is related to altered neurovascular tone. 65,66 Children with severe motor and intellectual disability, those with chronic ventilator dependency, or spastic/flaccid cerebral palsy may be at similar risk for developing VTE.…”

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

“…In a previous study on DVT in SMID patients, DVT was found in the femoral veins in most cases. 13) The most frequent site was the femoral vein in the present study. To evaluate reductions in multiple DVTs in the lower limbs by treatments, we prepared composite endpoints by changing the weight of scores by the region of thrombus formation, through which it was possible to summarize findings; however, precise evaluations were difficult because of the small number of patients.…”

“…We previously reported that the incidence of DVT was high in these patients. 10,13) In the present study, the frequency of DVT in SMID patients was investigated using lower extremity venous ultrasound. SMID patients with DVT, for whom no treatment method has been established, were administered an oral anticoagulant, warfarin, the standard treatment, or edoxaban tosilate hydrate (LIXIANA ® ), a non-vitamin K-inhibitory oral anticoagulant (NOAC) newly developed as a substitute for warfarin that is covered by national health insurance, and their efficacies and safeties were evaluated.…”