The prevention of deep venous thrombosis in physically restrained patients with schizophrenia

Marc de Hert (1) , Geraldine Einfinger (2) , Elien Scherpenberg (3) , Martien Wampers (2) , Joseph Peuskens (2)

1 psychotic disorders
2 Psychotic Disorders
3 Center for hospital sciences

Background: Physical restraint and seclusion are associated with several risks. Antipsychotic drug use increases this risk. Objective: To evaluate whether the risk of thromboembolism in physical restraint and seclusion of patients with psychosis, treated with antipsychotic medication, was considered by taking preventive measures. Method: Anonymous data on all consecutively admitted patients with schizophrenia, treated with antipsychotic medication, between 2002 and 2009, was analyzed. Diagnostic information and data about seclusion procedures and medication were collected. Preventive measures of thromboembolism in patients in physical restraint were assessed by reviewing case notes and the medication prescribed at the time of seclusion. Results: Seclusion of patients with psychosis is not uncommon. Out of 679 identified patients, 170 had been secluded (472 events). Physical restraint use was not a rare event (N seclusions with restraint use 296, 62.7%) . Pharmacological preventive measures (use of heparine dugs) were taken frequently in order to prevent DVT by physical restraint or isolation. Sixty-five (38.2%) out of 170 secluded patients, including a majority of patients who had been under physical restraint, had been administered anticoagulants at the time of seclusion. No cases of DVT occurred. Conclusions: Preventive measures were routinely administered in clinical practice and were effective in the prevention of DVT. For a clinical setting it is important to establish a clear and detailed management plan on seclusion and fixation taken into account all possible risks of physical restraint.

Mots clés: Medicine

Marc de Hert, Geraldine Einfinger, Elien Scherpenberg, Martien Wampers, Joseph Peuskens. The prevention of deep venous thrombosis in physically restrained patients with schizophrenia. International Journal of Clinical Practice, 2010, 64 (8), pp.1109. ⟨10.1111/j.1742-1241.2010.02380.x⟩. ⟨hal-00552651⟩