Clinical Characteristics and Management of Asymptomatic Thromboembolism in Psychiatric Inpatients: A Retrospective Study

Background: Venous thromboembolism (VTE) is a severe, life-threatening physical condition. However, the risk of developing VTE in patients with mental disorders has been insufficiently recognized.Methods: In this descriptive study, we retrospectively screened the hospital electronic medical record system and identified the asymptomatic VTE condition in hospitalized patients in the Mental Health Center, First Affiliated Hospital, Zhejiang University School of Medicine from January 2014 to January 2021. The diagnosis of VTE was made based on elevated plasma D-dimer levels and positive imaging findings, including arteriovenous color doppler ultrasonograpny of lower limbs and computed tomography angiography of pulmonary artery. For patients included, demographic and clinical profiles, and findings of laboratory and imaging examinations were collected. The anticoagulant therapy and clinical outcomes of these patients were also recorded.Results: A total of 8093 hospitalized patients were screened and eventually 24 psychiatric patients with asymptomatic VTE were included in the final analysis. The mean age of patients was 65.75±8.69 years old, with 20 patients (83.3%) older than 60 years. 18 (75%) patients were female and 6 (25%) were male. The number of patients with a history of smoking and previous pharmacotherapy was 3 and 19, respectively. And the average BMI of all subjects was 22.85±3.97, which was within the normal values. The average course of psychiatric disorders prior to the hospitalization was 9.15±10.38 years, the mean hospital stays were 23.17±9.14 days and the shortest hospital stay was 10 days. The average plasma levels of D-dimer before anticoagulant therapy was 4060.00±2824.88 ug/L FEU with a range of 920~10700 ug/L FEU (the normal range: 0~700 ug/L FEU). Following anticoagulant therapy, 83.3% (n=20) patients had a significant reduction in the plasma levels of D-dimer and the average reduced to 1678.25 ±1970.16 ug/L FEU, with a minimum level of 160 ug/L FEU. The plasma D-dimer levels between before and after anticoagulant treatment was significantly different (P＜0.05).Conclusion: Our data suggest the necessity screening the asymptomatic VTE among psychiatric patients, especially in those with advanced age, long duration of illness, and female with a long history of psychotropic treatment and high plasma levels of D-dimer. Once the diagnosis of asymptomatic VTE is confirmed, antithrombotic therapy should be initiated as early as possible to avoid fatal consequences.