Electroconvulsive Therapy for Catatonia With Deep Venous Thrombosis

Inagawa, Yuta; Saito, Suguru; Okada, Tsuyoshi; Inoue, Koju; Suda, Shiro

doi:10.4088/pcc.18m02286

Cited by 13 publications

(17 citation statements)

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“…In an analysis 9 of 8 patients receiving concomitant ECT and either edoxaban or apixaban for an acute DVT, 1 patient (12.5%) developed a PE during ECT. Reassuringly, other case reports 5,[10][11][12] have indicated that ECT sessions could be completed successfully and without complications after the development of a VTE. One published case report 5 even described safe resumption of ECT as soon as 3 days after heparin initiation for acute PE.…”

Section: Introductionmentioning

confidence: 87%

Safety of ECT in patients receiving an oral anticoagulant

Centanni¹,

Craig

Whitesell

et al. 2021

Mental Health Clinician

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Introduction This study assessed the use, tolerability, and safety of anticoagulation via direct oral anticoagulants or warfarin in medical and psychiatric inpatients receiving ECT. Methods This retrospective cohort study included 32 patients who received ECT while on either a direct oral anticoagulant (9) or warfarin (23) and spanned 247 encounters at Maine Medical Center between December 2012 and December 2018. Data are presented descriptively and analyzed using SPSS version 25 and Microsoft Excel version 2016. Results Among the 247 ECT patient encounters, there were few major adverse effects of ECT in this medically complex population. These adverse effects included headache during 4 encounters (1.6%), respiratory distress during 2 encounters (0.8%) and a cardiovascular event during 1 encounter (0.4%). One patient (3.1%) who was receiving concurrent rivaroxaban and venlafaxine experienced gastrointestinal bleeding that was determined to be unrelated to ECT. One patient on fluoxetine and warfarin experienced hemoptysis thought to be secondary to epistaxis. No other major bleeding or clotting event occurred during an ECT session nor for the duration of the hospitalization. Discussion Direct oral anticoagulants and warfarin appear safe in the treatment of patients with atrial fibrillation or acute venous thromboembolism who are receiving concomitant ECT. Prospective studies are needed to confirm these findings.

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Section: Introductionmentioning

confidence: 87%

Safety of ECT in patients receiving an oral anticoagulant

Centanni¹,

Craig

Whitesell

et al. 2021

Mental Health Clinician

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show abstract

“…22 Thromboembolic disease/atrial fibrillation (AF): Risk of pulmonary embolism exists, so location of deep venous thrombosis (DVT) should be determined, and anticoagulation should be continued. 23 Increasing the dose of neuromuscular relaxant is advised. Rate control and anticoagulation are advised for patients in AF to prevent embolic stroke.…”

Section: Specific Cardiac Pathologiesmentioning

confidence: 99%

Challenges during Electroconvulsive Therapy—A Review

Bansal

Surve

Dayananda

2021

J Neuroanaesth Crit Care

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Electroconvulsive therapy (ECT) is one of the most successful treatment techniques employed in psychiatric practice. ECT is usually administered as a last resort to a patient who fails to respond to medical management or on an urgent basis as a life-saving procedure when immediate response is desired. It is performed under general anesthesia and is often associated with autonomic changes. All attempts should be made to minimize the resulting hemodynamic disturbances in all the patients using various pharmacological methods. Anesthesiologists providing anesthesia for ECT frequently encounter patients with diverse risk factors. Concurrent cardiovascular, neurological, respiratory, and endocrine disorders may require modification of anesthetic technique. It is ideal to optimize patients before ECT. In this review, the authors discuss the optimization, management, and modification of anesthesia care for patients with various cardiac, neurological, respiratory, and endocrine disorders presenting for ECT to improve the safety of the procedure. It is not infrequent that an anesthesiologist also plays an important role in inducing a seizure. Proconvulsants such as caffeine, adjuvants like opioids, hyperventilation, and appropriate choice of anesthetic agent for induction such as etomidate or ketamine can help. The use of BIS monitoring to guide the timing of electric stimulation is also elaborated in this review.

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“…There have been incidences described in the literature where catatonic patients developed deep venous thrombosis and anticoagulation treatment was given to all of them before and during ECT sessions and, consequently, no bleeding-related complications were noted. Literature also suggests that the location of deep venous thrombosis might prove to be an important consideration in these patients as catatonic patients with proximal deep venous thrombosis are more likely to develop pulmonary embolism as a complication as compared to catatonic patients with distal deep venous thrombosis [9]. All of these catatonic patients were given muscle relaxants before the ECT session, so it could not be confirmed whether ECT was directly responsible for pulmonary embolism in one of the patients or other additional factors [9][10][11][12].…”

Section: Figure 1: Flowsheet Describing the Occurrence Of Thromboembomentioning

confidence: 99%

“…Literature also suggests that the location of deep venous thrombosis might prove to be an important consideration in these patients as catatonic patients with proximal deep venous thrombosis are more likely to develop pulmonary embolism as a complication as compared to catatonic patients with distal deep venous thrombosis [9]. All of these catatonic patients were given muscle relaxants before the ECT session, so it could not be confirmed whether ECT was directly responsible for pulmonary embolism in one of the patients or other additional factors [9][10][11][12]. Another literature review highlights three important points that ECT can be administered safely in the psychiatric patient with catatonia after the occurrence of pulmonary embolism, that is, by evaluation of cardiac function and residual deep venous thrombosis before resuming ECT therapy, adjustment of anticoagulation dose and by adopting preventive measures for recurrent deep venous thrombosis and pulmonary embolism like fluid administration, compression devices and timely ECT [13].…”

Section: Figure 1: Flowsheet Describing the Occurrence Of Thromboembomentioning

confidence: 99%

“…The severe muscle contraction during ECT session can dislodge the clot from residual deep venous thrombosis and embolize to other organs increasing the risk of pulmonary embolism. Literature shows that schizophrenia with catatonic patients having underlying proximal deep venous thrombosis (DVT) and managed with ECT develop pulmonary embolism as a complication while those catatonic patients with distal deep venous thrombosis and managed with ECT do not develop any complication [9].…”

Section: Introductionmentioning

confidence: 99%

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Association of the Thrombo-embolic Phenomenon with Electroconvulsive Therapy Treatment in Schizophrenia with Catatonia Patient

Warriach

Shamim

Saeed

et al. 2019

Cureus

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Catatonia is a condition in which patients manifest with a complex of symptoms of behavioral and motor abnormalities. This condition can present with schizophrenia, bipolar, depression, and certain neurological illnesses. In this article, we analyze the coincidence of deep venous thrombosis (DVT) in schizophrenia with catatonia patients managed with electroconvulsive therapy (ECT) and the possible outcome of complications as an adverse event. The conclusion drawn from this traditional review reveals the importance of early diagnosis and treatment intervention of catatonia patients with ECT. No bleedingrelated complications occurred with the use of anticoagulants by catatonic patients managed with ECT and having underlying thrombosis. Literature also indicates that ECT can be safely administered for patients with distal deep venous thrombosis (DVT) treated with anticoagulants, while those with proximal DVT, ECT should be halted and anticoagulation treatment should be continued until the resolution of DVT to safely resume the ECT sessions. A possible alternative to ECT therapy for the patients with refractory schizophrenia with catatonia (who have safety concerns) is recombinant transcranial magnetic stimulation (rTMS). Nonetheless, more studies are needed to support our assertion.

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Electroconvulsive Therapy for Catatonia With Deep Venous Thrombosis

Abstract: These results suggest that it is important to determine the location of a DVT and to continue anticoagulation therapy until a proximal DVT disappears before ECT is performed.

Cited by 13 publications

References 0 publications

Safety of ECT in patients receiving an oral anticoagulant

Safety of ECT in patients receiving an oral anticoagulant

Challenges during Electroconvulsive Therapy—A Review

Association of the Thrombo-embolic Phenomenon with Electroconvulsive Therapy Treatment in Schizophrenia with Catatonia Patient

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