Prophylaxis of venous thromboembolism in physically restrained psychiatric patients

Hilger, H. H.; Beckerath, Olga von; Kröger, Knut

doi:10.3109/13651501.2016.1174274

Cited by 6 publications

(5 citation statements)

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“… 41 Hans Hilger, on the other hand, concluded that in psychiatric patients who are restrained for less than 24 h, measures to prevent VTE in physically restrained psychiatric patients do not seem necessary. 42 In the present study, restraint was not a risk for progression of distal DVT. First, none of the psychiatric patients who were restrained had been restrained for more than 24 h and were loosened for 10 min at half-hour intervals.…”

Section: Discussionsupporting

confidence: 39%

“…The HAMD score was significantly higher in patients with proximal than in those with distal DVT (40 [33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51][52] points vs. 28 points, P＜0.001) (Figure 5). The HAMA score did not significantly differ between patients with proximal and distal DVT (P = 0.888).…”

Section: Characteristics and Risk Factors Of Mental Illnesses Associa...mentioning

confidence: 99%

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Incidence and Clinical Features of Venous Thromboembolism in Inpatients with Mental Illness

Wang

Yang

et al. 2023

Clin Appl Thromb Hemost

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Aims We investigated the incidence and clinical features of venous thromboembolism (VTE) in inpatients with mental illnesses. Methods We retrospectively analyzed records of inpatients with mental illnesses and confirmed VTE at The First Hospital of Hebei Medical University between August 2018 and July 2022. We recorded demographic characteristics, psychosis-related conditions, and thrombus distribution. Results Among 12939 patients diagnosed with mental illness, 156 (1.21%) presented with VTE at the first visit or during the disease course. Crude VTE incidence varied significantly across mental illnesses, being highest in patients with organic mental disorders (5.20%), followed by emotional disorders (1.10%), and others ( P < 0.001). Distal and proximal deep venous thromboses (DVT) occurred in 79.17% and 20.84% of patients, respectively. The Hamilton Depression Scale (HAMD) score was higher in patients with proximal DVT than in those with distal DVT ( P < 0.001). On multivariate analysis, the HAMD score (odds ratio [OR] 1.173, confidence interval [CI] 1.100−1.251, P＜0.001) was a risk factor and the Hamilton Anxiety Scale (HAMA) (OR 0.862, CI 0.796−0.934, P＜0.001), a protective factor against DVT progression. Conclusion VTE is not rare in patients with mental illnesses and is most commonly associated with organic mental disorders. Psychosis-related DVT typically shows a significantly high incidence of distal DVT. Prevention and early treatment in patients with severe depression and distal DVT can prevent DVT aggravation.

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Section: Discussionsupporting

confidence: 39%

Section: Characteristics and Risk Factors Of Mental Illnesses Associa...mentioning

confidence: 99%

Incidence and Clinical Features of Venous Thromboembolism in Inpatients with Mental Illness

Wang

Yang

et al. 2023

Clin Appl Thromb Hemost

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“…Family members believed the need for restraint and seclusion could be reduced by creating a stimulating environment in the care facility, introducing individualized occupational therapy programs along with listening, communicating, and assessing the needs of the older people. Patients often thought their opinions were not included in their treatment planning ( 16 ). Staff working in acute old age psychiatry inpatient units in Australia thought aggressive behavior in their patients was related to the environment and aggression occurred because staff did not listen to patients ( 39 ).…”

Section: Discussionmentioning

confidence: 99%

“…The use of CIs is associated with many negative physical and psychological outcomes, particularly in older adults who are physically vulnerable. These include falls, pressure injuries, depression, aggression, deep vein thrombosis/pulmonary embolism, longer length of hospital stay and death (2,7,(16)(17)(18). A survey of Finnish psychiatric inpatients aged between 18 and 65 years found that patients were unsatisfied with their overall treatment following physical restraint or seclusion (19).…”

Section: Introductionmentioning

confidence: 99%

Determinants of Non-emergency Use of Control Interventions in Older Canadian Psychiatric Inpatients: Analysizing the InterRAI Mental Health Electronic Health Records

et al. 2021

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Background: The use of control interventions (CIs; acute control medications, physical/mechanical restraint) is associated with negative physical and psychological outcomes, particularly in older adults who are physically vulnerable. The aims of this study were to: (i) report the rates of CI use in older psychiatric inpatients (age 65 – 84 and age 85+), and compare them with younger age groups (18 – 44, age 45 – 64); and (ii) identify the factors associated with non-emergency CI use in older psychiatric inpatients.Methods: Routinely collected interRAI Mental Health assessments from 2005 – 2018 in Ontario, Canada, were analyzed to determine the rates of CI use. Logistic regression models were used to examine the sociodemographic and clinical determinants of non-emergency and any CI use.Results: There were 226,119 (female: 48.6%) interRAI assessments, and 85% of those assessed were under 65 years of age. The rates of non-emergency CI use in the four age groups were: 18 – 44 = 9.4%, 45 – 64 = 8.3%, 65 – 84 = 9.9%, 85+ = 13.2%. The most significant determinants of non-emergency CI use in older adults were highest impairments in activities of daily living (ADL Short Form score 8–16: OR = 2.72, 95% CI = 2.42 – 3.06), highest levels of aggression (Aggressive Behavior Scale score 4 – 6: OR = 1.76, 95% CI = 1.57 – 1.98), and highest levels of positive psychotic symptoms (Positive Symptoms Scale score 9+: OR = 1.65, 95% CI = 1.43 – 1.90). Delirium, cognitive disorder diagnosis, cognitive impairment, and falls were also associated with increased CI use odds, as were having the reasons for admission be danger to self, danger to others or inability to care for self. Females were less likely to have non-emergency CI use (OR = 0.84, 95% CI = 0.73 – 0.95). Patients admitted from long-term care homes had significantly greater odds of non-emergency CI use compared with community admissions (OR = 1.18; 95% CI = 1.07 – 1.29).Conclusion: The higher rates of non-emergency CI use in older psychiatric inpatients is concerning. Alternative non-pharmacological and person-centered management strategies should be considered to support older psychiatric inpatients with functional impairment, positive symptoms, aggressive behavior, cognitive impairment and delirium. The use of CIs could be incorporated as a quality improvement activity to monitor changes at various service provision levels.

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“…Although the risk of venous thromboembolisms were still found to occur at a significant rate in prophylactically treated patients, 7 other studies and organizations are still evaluating the best method of prevention among this population. One study evaluating patients within their first days of hospitalization found that it appeared safe to withhold deep venous thrombosis prophylaxis treatment within the first 24 h, and subsequent low‐molecular‐weight heparin use for prophylaxis was safe among the patients studied 14 . Recognizing the risk of venous thromboembolism, Queensland Statewide Venous Thromboembolism Prevention guidelines recommend using Padua risk assessment model for mental health patients 15 .…”

Section: Discussionmentioning

confidence: 99%

Two pulmonary emboli in a psych pod

et al. 2020

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Background A female patient known to have schizoaffective disorder self‐presented to an emergency department in a state of acute agitation and paranoia shortly after a 35‐day inpatient stay at a psychiatric facility. Case report The patient exhibited no signs or complaints of dyspnea or hypoxia, but later collapsed and became hypoxic after sleeping comfortably with sedation for 12 h in the psychiatric unit. She was intubated and a computed tomography angiogram revealed bilateral lobar pulmonary emboli and right heart strain. Conclusion Psychiatric hospitalizations, medications, diagnoses and relevant sequelae increase venous thromboembolism risk more than many realize.

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Prophylaxis of venous thromboembolism in physically restrained psychiatric patients

Abstract: The concept of waiving VTE prophylaxis within the first 24 h of restraining seems to be safe. On the other hand, LMWH sufficiently protected the small sample being restrained for more than 24 h.

Cited by 6 publications

References 14 publications

Incidence and Clinical Features of Venous Thromboembolism in Inpatients with Mental Illness

Incidence and Clinical Features of Venous Thromboembolism in Inpatients with Mental Illness

Determinants of Non-emergency Use of Control Interventions in Older Canadian Psychiatric Inpatients: Analysizing the InterRAI Mental Health Electronic Health Records

Two pulmonary emboli in a psych pod

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