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, and such patients are associated with a high risk for the complications of deep vein thrombosis (DVT). Here we have reported 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 superficial femoral and common femoral veins. We applied anticoagulant therapy (warfarin), and carefully followed up the cases with DVT, regulating the warfarin dosage at PT-INR values around 2 for prevention of recurrence for chronic thrombosis. Regarding laboratory data for the coagulation system, there were no cases with above 5 μg/ml of the D-dimer. The plasma levels of D-dimer in patients with DVT diminished under 1.0 μg/ml after warfarin treatment. Concerning sudden death 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 underdeveloped vascular system from underlying diseases for the evaluation of DVT in patients with SMID. A detailed study of DVT as a vascular complication is very important for smoothly medical care of SMID, and serial assessment of compression Doppler ultrasonography of the lower extremity, as noninvasive examination and measurement of D-dimer, are very helpful.
