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Venous thromboembolism risk assessment in old age psychiatry

Published online by Cambridge University Press:  02 January 2018

Abid H. Choudry*
Affiliation:
Black Country Partnership NHS Foundation Trust, email: abidchoudry@doctors.org.uk
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Abstract

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Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Copyright
Copyright © Royal College of Psychiatrists, 2013

Van Zyl et al’s study Reference van Zyl, Wieczorek and Reilly1 highlights the importance of increased awareness of venous thromboembolism (VTE) in mental health services for older people. However, it is also important to be aware of the risks of thromboprophylaxis within this setting. The authors claim that the incidence rates of VTE in old age mental health services were comparable with those in general hospitals. However, it does not follow from this that the same approaches for VTE screening and thromboprophylaxis used in general hospitals should be applied, particularly with respect to the risks of thrombocytopenia and bleeding from prophylactic low molecular weight heparin, 2 which may be exacerbated in mental health in-patient settings, where the average length of stay is likely to be longer than in an acute medical unit. In fact, recent meta-analyses have questioned whether such risks outweigh the potential benefits even within the general hospital setting. 3 Further evidence should be sought before such VTE prevention strategies are widely implemented in mental healthcare settings, lest they lead to patient harm.

References

1 van Zyl, M, Wieczorek, G, Reilly, J. Venous thromboembolism incidence in mental health services for older people: survey of in-patient units. Psychiatrist 2013; 37: 283–5.CrossRefGoogle Scholar
2 National Collaborating Centre for Acute and Chronic Conditions. Venous Thromboembolism – Reducing the Risk. Reducing the Risk of Venous Thromboembolism (Deep Vein Thrombosis and Pulmonary Embolism) in Patients Admitted to Hospital (NICE Clinical Guideline 92). NICE, 2010.Google Scholar
3 Department of Health. Venous Thromboembolism (VTE) Risk Assessment (Gateway reference 10278). Department of Health, 2010.Google Scholar
4 Roopen, A (ed.) Venous Thromboembolism Prevention: A Patient Safety Priority. King's Thrombosis Centre, 2009.Google Scholar
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