title: 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: 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.).
authors.affiliation: Department of Pediatrics, National Hospital Organization, Yanai Medical Center, Yanai, Yamaguchi, Japan.
authors.forename: Hiromitsu
authors.initials: H
authors.lastname: Ohmori
authors.affiliation: Department of Surgery, Katoh City Hospital, Kato, Hyogo, Japan.
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Kanaoka
authors.affiliation: Department of Neurology, National Hospital Organization, Yanai Medical Center, Yanai, Yamaguchi, Japan.
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Murata
authors.affiliation: Department of Neurology, National Hospital Organization, Yanai Medical Center, Yanai, Yamaguchi, Japan.
authors.forename: Masami
authors.initials: M
authors.lastname: Yamasaki
authors.affiliation: Department of Laboratory, National Hospital Organization, Yanai Medical Center, Yanai, Yamaguchi, Japan.
authors.forename: Hiroko
authors.initials: H
authors.lastname: Takesue
authors.affiliation: Department of Internal Medicine, National Hospital Organization, Yanai Medical Center, Yanai, Yamaguchi, Japan.
authors.forename: Nobuo
authors.initials: N
authors.lastname: Matsumoto
authors.affiliation: Department of Surgery, National Hospital Organization, Yanai Medical Center, Yanai, Yamaguchi, Japan.
authors.forename: Ryo
authors.initials: R
authors.lastname: Sumimoto
authors.affiliation: Department of Vascular Surgery, Hitachi Memorial Hospital, Yasugi, Shimane, Japan.
authors.forename: Shigetsugu
authors.initials: S
authors.lastname: Ohgi
keywords: D-dimer; chronic deep vein thrombosis (DVT); severe motor and intellectual disabilities (SMID); ultrasonography