Presentation and clinical evolution of Pulmonary Embolism in patients with Mental Disorders

Introduction: In Patients with Mental Disorders (MD) the risk of venous thromboembolic disease has increased. There is little information regarding these patients during acute pulmonary embolism (PE). Objectives and Methods: This was a retrospective observational cohort study performed in a tertiary hospital in Spain. All patients with a primary diagnosis of PE between October 2015-September 2017 were included. The objective of the study was to compare the clinical presentation and the treatment of patients diagnosed of PE with and without MD. Results: One hundred fifty-three consecutive patients were included. Thirty-six (23.6%) had MD [depression 8(22%), anxiety 12(33%), schizophrenia 1(4%), bipolar 1(4%); more than one MD 14 (37%)]. Patients with MD were older compared to patients without MD (mean±SD, 75 ±9 vs 69 ±8 years, p=0.008) and mainly women (80% vs 56%, p=0.007). There were no significant differences in risk factors, comorbidities or clinical presentation. High levels of pro-BNP were showed in patients with MD (5499 ± 3120 vs 1764 ± 2692 pg/ml, p=0.01). Although the treatment was more conservative in patients with MD (97% of patients treated with low molecular weight heparin vs. 82% in the other group, p=0.040), hospital stay was longer in the MD group (11.9 ±6 vs 7.7 ±7 days, p=0.025). Among patients treated with psychotropic drugs, only patients in treatment with antipsychotics (n=9, 25%) were found to have a higher mortality at 90 days (p=0.044). Conclusions: Although conservative treatment of pulmonary embolism was predominant in the context of mental disorder, this was associated with a longer hospital stay. Patients on antipsychotic therapy may represent a potential higher risk population