Prophylactic use of heparin for deep vein thrombosis in restrained psychiatric patients: a chart review

• Published in: General hospital psychiatry 2014-11, Vol.36 (6), p.690-693
• Main Authors: Ishida, Takuto, M.D, Suzuki, Takefumi, M.D., Ph.D, Watanabe, Koichiro, M.D., Ph.D, Sakurai, Hitoshi, M.D, Uchida, Hiroyuki, M.D., Ph.D, Mimura, Masaru, M.D., Ph.D
• Format: Article
• Language: English
• Subjects: Adult; Anticoagulants - administration & dosage; Anticoagulants - pharmacology; Biological and medical sciences; Blood and lymphatic vessels; Cardiology. Vascular system; Comorbidity; Conscious Sedation - adverse effects; Deep vein thrombosis; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous; Female; General aspects; Heparin; Heparin - administration & dosage; Heparin - pharmacology; Hospitals, Psychiatric; Humans; Inpatients; Male; Medical sciences; Mental Disorders - epidemiology; Mental Disorders - therapy; Middle Aged; Pneumology; Psychiatry; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Pulmonary embolism; Pulmonary hypertension. Acute cor pulmonale. Pulmonary embolism. Pulmonary vascular diseases; Restraint; Restraint, Physical - adverse effects; Retrospective Studies; Sedation; Time Factors; Treatment Outcome; Venous Thrombosis - drug therapy; Venous Thrombosis - epidemiology; Venous Thrombosis - etiology
• ISSN: 0163-8343; 1873-7714
• DOI: 10.1016/j.genhosppsych.2014.06.007

Abstract Objective Physical restraint sometimes causes deep vein thrombosis (DVT) and pulmonary embolism. Although unfractionated heparin (UFH) is used for the prophylaxis of DVT, its effectiveness remained unknown for restrained patients. Method We conducted a chart review of restrained inpatients at Sakuragaoka Memorial Hospital in Japan. Restrained patients received subcutaneous injection of UFH 5000 IU bid from December 2008 to September 2010 [heparin (+) period] while UFH was not used from December 2010 to September 2012 [heparin (−) period]. A Doppler ultrasound scanning was performed to examine the presence of DVT. The incidence of DVT was compared between the two periods by chi-square test. A multiple logistic regression model was used to examine effects of demographic and clinical characteristics on the incidence of DVT. Results No significant difference was found in the incidence of DVT between the heparin (+) and (−) periods [11.8% (11/93) vs. 11.1% (13/117)]. Sedation [odds ratio (OR)=3.78], physical comorbidities (OR=6.29) and a longer duration of restraint (OR=1.22) were associated with the incidence of DVT. Conclusion The use of UFH was not associated with any reduction in the incidence of DVT in restrained psychiatric patients.