Abstract
A 43-year-old woman with severe motor and intellectual disabilities (SMID) presented with left leg swelling that appeared suddenly following symptoms of respiratory infection including fever. Using ultrasonography, we detected extensive thrombosis from the common iliac vein to the soleus muscle vein despite the fact that the patient had no evidence of coagulation abnormalities or other risk factors for thrombosis. Use of the factor Xa inhibitor apixaban dramatically reduced the thrombi and associated leg swelling. It is widely accepted that patients with SMID are at greater risk of deep vein thrombosis (DVT) because of their reduced voluntary movements and their respiratory insufficiency. Unfortunately, most reports of DVT in these patients are subclinical and discovered accidentally. Therefore, we recommend that SMID patients, whether asymptomatic or with some degree of leg swelling, be routinely examined using ultrasonography to check for DVT. In addition, we recommend the use of factor Xa inhibitor anticoagulants for the treatment of patients with DVT because of the low risk of bleeding associated with these drugs.
