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Clinical Study of Venous Thromboembolism in Psychiatric Inpatients Subjected to Physical Restraints Riki MATSUNAGA 1 , Takashi GOMIBUCHI 1 , Toru WAKEJIMA 1 , Yuji OKAZAKI 1 1Department of Psychiatry, Tokyo Metropolitan Matsuzawa Hospital, Tokyo, Japan Keyword: Psychiatric inpatient , Physical restraint , Deep vein thrombosis , Venous thromboembolism , Prevention of pulmonary thromboembolism pp.739-746
Published Date 2009/8/15
DOI https://doi.org/10.11477/mf.1405101465
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 The prevention of pulmonary thromboembolism in psychiatric inpatients with physical restraints is a significant challenge in the clinical field. However, to our knowledge, no study has reported the prevalence and clinical characteristics of venous thromboembolism (VTE) among patients in the psychiatric ward.

 Thus, we investigated the prevalence and risk factors of VTE in 422 patients admitted 2 psychiatric units of our hospital after subjecting them to physical restraints. All subjects wore graduated compression stockings (GCS), and 283 patients were administered a low dose unfractionated heparin (5,000 U 12-hourly subcutaneously or 10,000 U daily by continuous intravenous injection) for prophylaxis against VTE.

 In total, 42 cases had deep vein thrombosis, which was detected with Doppler ultrasonography or computed tomography. A diagnosis of symptomatic pulmonary thromboembolism was made in 4 patients by performing chest CT or autopsy. The prevalence of VTE was observed to be lower when anticoagulant prophylaxis was provided in combination with GCS than with GCS alone (6.4% vs 17.3%). The rates of VTE were observed to be higher in the group subjected to physical restraints that did not involve the legs than in those subjected to restraints involving them.

 The administration of anticoagulants to patients subjected to physical restraints was considered to be effective for prophylaxis against VTE. Further studies are needed to confirm this observation. Moreover, we recommend the administration of adequate thromboprophylaxis with anticoagulants and/or using mechanical methods, such as GCS and intermittent pneumatic compression, with or without leg restraints to patients subjected to physical restraints.


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電子版ISSN 1882-126X 印刷版ISSN 0488-1281 医学書院

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