Prevalence of Venous Thromboembolism Among Inpatients With Depression Justifies Greater Screening

Among inpatients with depression, it is important to screen for venous thromboembolism (VTE), as the results of an analysis recently published in Neuropsychiatric Disease and Treatment demonstrated a VTE prevalence of 8.5% in this population.

The investigators sought to evaluate VTE prevalence and the factors associated with the condition among depressed inpatients from the Psychiatry Department of Akita University Hospital in Akita, Japan. They performed their study among a total of 94 inpatients with depression between January 1, 2018, and June 30, 2019. All of the patients with depression were screened for VTE with the use of D-dimer. Following this, those individuals who tested positive—that is, those with abnormal D-dimer values—underwent enhanced computed tomography (CT) scans in order to reach a diagnosis within 12 hours of measuring the D-dimer concentrations. VTE included pulmonary embolism (PE) and deep vein thrombosis (DVT).

For all participants, data were obtained from medical records with respect to the following parameters: age, sex, BMI, diagnosis of psychiatric disorders, duration of current depressive episode, total scores on the 17-item Hamilton Depression (HAM-D₁₇) Rating Scale, daily dosages of antidepressants and antipsychotics, use of physical restraint, and occurrence of catatonia. Treatments for VTE included the following: anticoagulants, graduated compression stockings, and intermittent pneumatic compression devices.

Among the 94 adult Japanese patients (mean age, 62.4±16.3 years; 65 women), 89 patients were hospitalized from the community, 3 were transferred from other psychiatric hospitals, and 2 were transferred from other wards at the same psychiatric hospital. None of the patients were evaluated for VTE prior to D-dimer measurements. A total of 92 of the 94 patients underwent VTE screening; 2 patients did not undergo the screening within 7 days of being hospitalized.  

Overall, 26 patients screened positive for VTE. Next, 24 of these individuals underwent enhanced CT. Among all of the patients with depression, 8 of 94 (8.5%) were ultimately diagnosed with VTE per enhanced CT (3 participants with DVT only, 4 participants with PE only, and 1 patient with both PE and DVT). All of those with DVT had distal DVT.

Furthermore, all of the participants diagnosed with VTE were asymptomatic. All individuals with VTE reported improvement upon being treated with anticoagulant therapy, with no side effects observed. Per univariate analysis, no significant differences were demonstrated between VTE-positive and VTE-negative individuals in terms of any of the factors noted, including sex, age, BMI, diagnoses of psychiatric disorders, HAM-D₁₇ scores, duration of the current psychiatric episode, daily dosages of antidepressant and antipsychotic medications, and catatonia.

A major limitation of the study was the lack of statistical power due to relatively small sample size. Also, as a result of the retrospective nature of the study, risk factors for VTE such as dehydration, immobility, smoking, and drinking could not be assessed.

The investigators concluded that the 8.5% prevalence of VTE among the inpatients with depression who were evaluated is higher than that usually reported in hospitalized patients with mental disorders. Thus, these findings underscore the importance of VTE screening among inpatients who are experiencing depression.

Reference

Takeshima M, Ishikawa H, Umeta Y, et al. Prevalence of asymptomatic venous thromboembolism in depressive inpatients. Neuropsychiatr Dis Treat. 2020;16:579-587. doi: 10.2147/NDT.S243308.