Background Pulmonary 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. Methods This cross-sectional study assessed the presence of deep vein thrombosis using bilateral leg Doppler ultrasonography in 114 asymptomatic outpatients with Parkinson’s disease. Results Deep 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. Conclusion Presence 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.
References
[1]
Pforte A (2004) Epidemiology, diagnosis, and therapy of pulmonary embolism. Eur J Med Res 9: 171-179. PubMed: 15210397.
[2]
Samuel ZG, Luigi V, Marisa DR (1999) Acute pulmonary embolism: clinical outcomes in the International Cooperative Pulmonary Embolism Registry (ICOPER). Lancet 353: 1375-1376. doi:10.1016/S0140-6736(99)90053-3. PubMed: 10227212.
[3]
Gaber TA (2007) Guidelines for prevention of venous thromboembolism in immobile patients secondary to neurological impairment. Disabil Rehabil 29: 1544-1549. doi:10.1080/09638280601055618. PubMed: 17852233.
[4]
Kimura F, Ishida S, Furutama D, Hirata Y, Sato T et al. (2006) Wheelchair economy class syndrome in amyotrophic lateral sclerosis. Neuromuscul Disord 16: 204-207. doi:10.1016/j.nmd.2005.12.006. PubMed: 16487707.
Mosewich RK, Rajput AH, Shuaib A, Rozdilsky B, Ang L (1994) Pulmonary embolism: an under-recognized yet frequent cause of death in Parkinsonism. Mov Disord 9: 350-352. doi:10.1002/mds.870090316. PubMed: 8041379.
[7]
Doherty KM, van de Warrenburg BP, Peralta MC, Silveira-Moriyama L, Azulay JP et al. (2011) Postural deformities in Parkinson’s disease. Lancet Neurol 10: 538-549. doi:10.1016/S1474-4422(11)70067-9. PubMed: 21514890.
[8]
Gibb WRG, Lees AJ (1989) The significance of the Lewy body in the diagnosis of idiopathic Parkinson’s disease. Neuropathol Appl Neurobiol 15: 27-44. doi:10.1111/j.1365-2990.1989.tb01147.x. PubMed: 2542825.
[9]
Bounameaux H, Perrier A, Righini M (2010) Diagnosis of venous thromboembolism: an update. Vasc Med 15: 399-406. doi:10.1177/1358863X10378788. PubMed: 20926499.
[10]
Tomlinson CL, Stowe R, Patel S, Rick C, Gray R et al. (2010) Systematic review of levodopa dose equivalency reporting in Parkinson’s disease. Mov Disord 25: 2649-2653. doi:10.1002/mds.23429. PubMed: 21069833.
[11]
Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N et al. (1999) Modification of Diet Renal Disease Study Group. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Ann Intern Med 130: 461-470. PubMed: 10075613.
[12]
Kniffin WD, Baron JA, Barrett J, Birkmeyer JD, Anderson FA (1994) The epidemiology of diagnosed pulmonary embolism and deep venous thrombosis in the elderly. Arch Intern Med 154: 861-866. doi:10.1001/archinte.1994.00420080053005. PubMed: 8154949.
[13]
Oger E (2000) Incidence of venous thromboembolism: a community-based study in Western France. EPI-GETBP Study Group. Thromb Haemost 83: 657-660.
[14]
Gaber TA, Kirker SG, Jenner JR (2002) Current practice of prophylactic anticoagulation in Guillain-Barr syndrome. Clin Rehabil 16: 190-193. doi:10.1191/0269215502cr475oa. PubMed: 11926177.
[15]
Kelly J, Rudd A, Lewis R, Hunt BJ (2010) Risk of deep venous thrombosis (DVT) in bedridden or wheelchair-bound multiple sclerosis patients: a prospective study. Thromb Res 125: 315-317. doi:10.1016/j.thromres.2009.06.023. PubMed: 19640570.
[16]
Kelly J, Rudd A, Lewis R, Hunt BJ (2001) Venous thromboembolism after acute stroke. Stroke. 32: 262-267. doi:10.1161/01.STR.32.1.262. PubMed: 11136946.
[17]
Oczkowski WJ, Ginsberg JS, Shin A, Panju A (1992) Venous thromboembolism in patients undergoing rehabilitation for stroke. Arch Phys Med Rehabil 73: 712-716. PubMed: 1642519.
[18]
Burbridge BE, Wallace JK, Rajput A, McCulloch L (1999) Doppler ultrasonographic examination of the leg veins of patients with Parkinson disease. J Psychiatry Neurosci 24: 338-340. PubMed: 10516801.
[19]
Righini M, Paris S, Le Gal G, Laroche JP, Perrier A et al. (2006) Clinical relevance of distal deep vein thrombosis - review of literature data. Thromb Haemost 95: 56-64. PubMed: 16543962.
[20]
Stein PD, Matta F, Musani MH, Diaczok B (2010) Silent pulmonary embolism in patients with deep venous thrombosis: a systematic review. Am J Med 123: 426-431. doi:10.1016/j.amjmed.2009.09.037. PubMed: 20399319.
Biglan KM, Holloway RG, McDermott MP, Richard IH, Study Parkinson Group. CALM-PD Investigators (2007) Risk factors for somnolence, edema, and hallucinations in early Parkinson disease. Neurology 69: 187-195.
[23]
Antonini A, Tolosa E, Mizuno Y, Yamamoto M, Poewe WH (2009) A reassessment of risks and benefits of dopamine agonists in Parkinson’s disease. Lancet Neurol 10: 929-937. PubMed: 19709931.
[24]
Subramaniam RM, Chou T, Heath R, Allen R (2006) Importance of pretest probability score and D-dimer assay before sonography for lower limb deep venous thrombosis. AJR Am J Roentgenol 186: 206-212. doi:10.2214/AJR.04.1398. PubMed: 16357403.
[25]
Cruickshank JM (1988) Air travel and thrombotic episodes: the economy class syndrome. Lancet. 2: 497-498. PubMed: 2900413.
[26]
Djaldetti R, Hellmann M, Melamed E (2004) Bent knees and tiptoeing: late manifestations of end-stage Parkinson’s disease. Mov Disord 19: 1325-1328. doi:10.1002/mds.20187. PubMed: 15389997.
[27]
Gerkin TM, Beebe HG, Williams DM, Bloom JR, Wakefield TW (1993) Popliteal vein entrapment presenting as deep venous thrombosis and chronic venous insufficiency. J Vasc Surg 18: 760-766. doi:10.1067/mva.1993.48846. PubMed: 8230561.
[28]
Petrauskiene V, Falk M, Waernbaum I, Norberg M, Eriksson JW (2005) The risk of venous thromboembolism is markedly elevated in patients with diabetes. Diabetologia. 48: 1017-1021. doi:10.1007/s00125-005-1715-5. PubMed: 15778859.
[29]
Samama MM, Horellou MH, Elalamy I, Mathieux V, Ombandza-Moussa E et al. (2005) D-dimer levels, constitutional thrombophilia, and venous thrombosis prediction: clinical aspects and implications. Semin Vasc Med 5: 371-374. doi:10.1055/s-2005-922482. PubMed: 16302158.
[30]
Kesieme E, Kesieme C, Jebbin N, Irekpita E, Dongo (2011) A Deep vein thrombosis: a clinical review. J Blood Med. 2: 59-69. PubMed: 22287864.