Abstract:

Objective To improve the early recognition and early diagnosis of venous thromboembolism (VTE) in patients with psychiatric disorders. Methods Clinical symptoms, laboratory and imaging tests, anti-psychotic medication and treatment prognosis of 16 patients with psychiatric disorders combined with VTE who were first diagnosed in the Department of Mental Health, Sir Run Run Shaw Hospital affiliated to Zhejiang University from May 2019 to March 2022 were retrospectively analyzed. Results Among the 16 patients, there were 6 males and 10 females with an average age of 67 years. 13/16 were diagnosed with pulmonary embolism, 4/16 were diagnosed as deep venous thrombosis, and 1 suffered pulmonary embolism complicated with deep venous thrombosis. The diagnosis of pulmonary embolism and deep venous thrombosis was confirmed following the Chinese guidelines for the prevention and treatment of thrombotic diseases 2018 edition. 12 cases of pulmonary embolism were low-risk and one case was high-risk. Two patients had transient chest tightness and shortness of breath before onset, while the remaining 14 patients had no obvious symptoms of chest tightness and shortness of breath. 16 patients had abnormal D-dimer, 9 had hyperlipidemia, 8 had hyperhomocysteinemia, 5 had hyperprolactinemia and 2 had elevated coagulation factor VIII. 10 patients had VTE within the first 6 months of antipsychotic use. 3 cases occurred within 1 year and 3 cases occurred within 5 years. Olanzapine was given to all 16 patients. The risk of thrombosis was low in all 16 patients, as assessed by the Caprini and Padua Thrombosis Risk Assessment Scale. Conclusion The clinical presentation of VTE in patients with psychiatric disorders is atypical that lacks obvious clinical signs and symptoms, easily leading to misdiagnosed and untimely treatment. Conventional VTE prevention assessment scales are not suitable for them. VTE in patients with psychiatric disorders most often occurs within the first 6 months of olanzapine use, which is often associated with abnormal elevations in D-dimer and other metabolic laboratory markers. Concurrent olanzapine use in patients with psychiatric disorders may precipitate VTE and requires significant clinical attention.

Key words: venous thromboembolism, pulmonary thromboembolism, antipsychotic drugs, olanzapine, mental illness