Hospital Associated Thrombosis (HAT) is defined as venous thromboembolism (VTE) diagnosed during hospitalisation or within 90 days of discharge following an in-patient stay.1
The 2018 NICE VTE Guidelines on HAT (NG89) recommended that acute psychiatric in-patients should have VTE risk assessment and appropriate thromboprophylaxis.1 Despite this, the existing Department of Health VTE risk assessment tool does not include specific mention of factors relevant to psychiatric inpatients.
There is limited data on the incidence of HAT in psychiatric in-patients, however in 2024 Codling D, Mueller C, Patel J, Stewart R, Arya R, and Roberts L. published a paper on ‘Rates of venous thromboembolism associated with acute psychiatric admission: A retrospective cohort study15’.
The study was a retrospective cohort study looking at VTE incidence in patients admitted to a psychiatric unit compared to community controls. The incidence of VTE within 3 months of admission to a psychiatric ward was 1.5 per 1,000 admissions. Although the study was not powered to find a statistically significant difference, it was striking that there were 11 cases amongst admitted patients with none in the control group of community mental health patients.
While there is no data on HAT morbidity and mortality in psychiatric in-patients in the British system; although we know HAT cases do occur and reach the coroner, requiring post-mortem. 3 There is an increasing body of evidence that patients with severe mental illness are at increased risk of VTE.
Regulation 28 ‘Hospital Death (Clinical Procedures and medical management) related deaths (VTE)
Regulation 28 ‘Mental Health related deaths’ (VTE)
There is considerable evidence that antipsychotic medicines are associated with VTE 5-10.
A recent meta-analysis, identified differences in risk between different antipsychotics.
This, and another meta-analyses9 found high levels of heterogeneity among the studies, and scarce data for individual antipsychotics, meaning these results must be interpreted with caution. 8-9
The association of antidepressant medication with VTE and bleeding risks were interpreted differently in MHTs, with one citing them as a thrombotic risk factor, and two listed SSRIs/SNRIs antidepressants as a bleeding risk.
Evidence suggests that antidepressant use carries a slightly increased VTE risk. 11-12Two meta-analyses identified that VTE risk when comparing antidepressant use with no antidepressant was small RR 1.27( 95% CI 1.06-1.51) 11 in one and OR 1.27 (95% CI 1.09-1.49) in the other.12
The current evidence does not suggest inclusion of antidepressants as a thrombotic risk factor in RAT, but further research is required.
Bleeding risk with SSRI use was assessed in a meta-analysis of 42 observational studies demonstrating a significant association (OR 1.41; 95% CI 1.27-1.57), 13 while another meta-analysis of 22 studies identified that upper GI bleeding was greater in SSRI users compared to non- users (OR 1.55; 95% CI 1.35-1.78), and the association was greatest for those also taking NSAIDs or anti-platelet medications. 14
Bleeding risks and thrombotic risks associated with antidepressants require further research in the context of VTE RAT.
The investigation also identified incidents where physical health monitoring had not supported recognition of changes in a patient’s long-term condition or prevented known complications from care.
2.2.25 ‘…where patients had developed blood clots contributed to by inactivity and dehydration. The assessment for and prevention of blood clots was a further concern in reports to prevent future deaths.’
Showed a risk rate increase of VTE of about 1.5 and concluding, ‘any potential benefits of antipsychotic treatment need to be weighed against risk of serious harm and treatment plans should be reviewed regularly.’
In 2021, a group of interested physicians joined with Thrombosis UK to assess HAT prevention practice in all 71 NHS England Mental Health Trusts (MHTs) via a survey sent by Thrombosis UK, through a Freedom of Information (FOI) request, in June 2021. Information requested included details of HAT policy, risk assessment tools (RAT), and HAT rates in the last five years. Data was analysed using simple statistical analysis.
The group and activity received no funds, grants, or support. There were no competing relevant financial or non-financial interests and all members authors contributed to the group and subsequent study conception and design. Material preparation, data collection and analysis were performed by A Purcell, BJ Hunt, M Cheah, J Jerrome and A Mohamed. All authors contributed to the manuscript and read and approved the final manuscript.
Prevention Of Hospital Associated Venous Thromboembolism In Psychiatric Inpatients: A Survey Of Current Practice Within Mental Health Trusts In England
Dr. A. Mohamed, Dr. M. Cheah, Professor B. Hunt, Dr J. Jenkinson, J. Jerrome, A. Purcell
Presented at the Royal College of Psychiatrists International Congress June 2022
The study highlighted that MHTs have identified multiple issues unique to mental health care they consider as risk factors for HAT. These include:
While many of these factors seem logical to consider, there is scanty published evidence on these risk factors.
The groups considers priority questions should include:
The survey results indicate an urgent need for policy and guideline makers to review the variation in RATs used in psychiatric in-patients, with a priority goal to harmonise a national risk assessment tool. In the interim, we wish to encourage those MHTs without a HAT prevention policy to implement one, for those with adapted RATs to review their tools, and for all to collect HAT rates systematically.
References
Available on https://doi.org/10.3892/etm.2024.12476. PMID: 38533433; PMCID: PMC10964734
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Applications are accepted on the basis that Thrombosis UK can share the content with external judges who will assist us with assessments. Service models, resources and working processes of successful Thrombosis UK VTE Award winners will be uploaded to the Thrombosis UK website and shared via publications, social media, and other opportunities.
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We wish to make you aware that your name and contact details, as included on your completed application form, will be viewed by the Thrombosis UK appointed Judging Panel solely for the purpose of reviewing and assessing your completed application. If your nomination is short listed, a representative from Thrombosis UK will then seek your permission to include your name on the summary paragraph included in the awards brochure and on the Thrombosis UK website.
Thrombosis UK takes security and confidentiality very seriously. Your name and contact details will never be passed or shared with any third party or an unauthorised individual. If you have any queries, please contact: [email protected]
Applications are accepted on the basis that Thrombosis UK can share the content with external judges who will assist us with assessments. Service models, resources and working processes of successful Thrombosis UK VTE Award winners will be uploaded to the Thrombosis UK website and shared via publications, social media, and other opportunities.
When completing your application form, you should use lay language and answer each question in a concise manner.
Please keep to any word limits given.
All sections need to be completed, if any section is removed, omitted or incomplete, we cannot process the application.
Applications need to be submitted via email to: [email protected] You will receive a notification of receipt within 48 hours of submission. If you do not receive a notification, please email [email protected]
The closing date for applications is 1st February 2025
We are unable to consider late applications.
Thrombosis UK has a strict data protection policy that complies with UK data protection law.
Your name and contact details may be stored for up to 12 months in order for correspondence relating to your application be appropriately processed.
We wish to make you aware that your name and contact details, as included on your completed application form, will be viewed by the Thrombosis UK appointed Judging Panel solely for the purpose of reviewing and assessing your completed application. If your nomination is short listed, a representative from Thrombosis UK will then seek your permission to include your name on the summary paragraph included in the awards brochure and on the Thrombosis UK website.
Thrombosis UK takes security and confidentiality very seriously. Your name and contact details will never be passed or shared with any third party or an unauthorised individual. If you have any queries, please contact: [email protected]
Applications are accepted on the basis that Thrombosis UK can share the content with external judges who will assist us with assessments. Service models, resources and working processes of successful Thrombosis UK VTE Award winners will be uploaded to the Thrombosis UK website and shared via publications, social media, and other opportunities.
When completing your application form, you should use lay language and answer each question in a concise manner.
Please keep to any word limits given.
All sections need to be completed, if any section is removed, omitted or incomplete, we cannot process the application.
Applications need to be submitted via email to: [email protected] You will receive a notification of receipt within 48 hours of submission. If you do not receive a notification, please email [email protected]
The closing date for applications is 1st February 2025
We are unable to consider late applications.
Thrombosis UK has a strict data protection policy that complies with UK data protection law.
Your name and contact details may be stored for up to 12 months in order for correspondence relating to your application be appropriately processed.
We wish to make you aware that your name and contact details, as included on your completed application form, will be viewed by the Thrombosis UK appointed Judging Panel solely for the purpose of reviewing and assessing your completed application. If your nomination is short listed, a representative from Thrombosis UK will then seek your permission to include your name on the summary paragraph included in the awards brochure and on the Thrombosis UK website.
Thrombosis UK takes security and confidentiality very seriously. Your name and contact details will never be passed or shared with any third party or an unauthorised individual. If you have any queries, please contact: [email protected]
Applications are accepted on the basis that Thrombosis UK can share the content with external judges who will assist us with assessments. Service models, resources and working processes of successful Thrombosis UK VTE Award winners will be uploaded to the Thrombosis UK website and shared via publications, social media, and other opportunities.
When completing your application form, you should use lay language and answer each question in a concise manner.
Please keep to any word limits given.
All sections need to be completed, if any section is removed, omitted or incomplete, we cannot process the application.
Applications need to be submitted via email to: [email protected] You will receive a notification of receipt within 48 hours of submission. If you do not receive a notification, please email [email protected]
The closing date for applications is 1st February 2025
We are unable to consider late applications.
Thrombosis UK has a strict data protection policy that complies with UK data protection law.
Your name and contact details may be stored for up to 12 months in order for correspondence relating to your application be appropriately processed.
We wish to make you aware that your name and contact details, as included on your completed application form, will be viewed by the Thrombosis UK appointed Judging Panel solely for the purpose of reviewing and assessing your completed application. If your nomination is short listed, a representative from Thrombosis UK will then seek your permission to include your name on the summary paragraph included in the awards brochure and on the Thrombosis UK website.
Thrombosis UK takes security and confidentiality very seriously. Your name and contact details will never be passed or shared with any third party or an unauthorised individual. If you have any queries, please contact: [email protected]
Applications are accepted on the basis that Thrombosis UK can share the content with external judges who will assist us with assessments. Service models, resources and working processes of successful Thrombosis UK VTE Award winners will be uploaded to the Thrombosis UK website and shared via publications, social media, and other opportunities.
When completing your application form, you should use lay language and answer each question in a concise manner.
Please keep to any word limits given.
All sections need to be completed, if any section is removed, omitted or incomplete, we cannot process the application.
Applications need to be submitted via email to: [email protected] You will receive a notification of receipt within 48 hours of submission. If you do not receive a notification, please email [email protected]
The closing date for applications is 1st February 2025
We are unable to consider late applications.
Thrombosis UK has a strict data protection policy that complies with UK data protection law.
Your name and contact details may be stored for up to 12 months in order for correspondence relating to your application be appropriately processed.
We wish to make you aware that your name and contact details, as included on your completed application form, will be viewed by the Thrombosis UK appointed Judging Panel solely for the purpose of reviewing and assessing your completed application. If your nomination is short listed, a representative from Thrombosis UK will then seek your permission to include your name on the summary paragraph included in the awards brochure and on the Thrombosis UK website.
Thrombosis UK takes security and confidentiality very seriously. Your name and contact details will never be passed or shared with any third party or an unauthorised individual. If you have any queries, please contact: [email protected]
Applications are accepted on the basis that Thrombosis UK can share the content with external judges who will assist us with assessments. Service models, resources and working processes of successful Thrombosis UK VTE Award winners will be uploaded to the Thrombosis UK website and shared via publications, social media, and other opportunities.
When completing your application form, you should use lay language and answer each question in a concise manner.
Please keep to any word limits given.
All sections need to be completed, if any section is removed, omitted or incomplete, we cannot process the application.
Applications need to be submitted via email to: [email protected] You will receive a notification of receipt within 48 hours of submission. If you do not receive a notification, please email [email protected]
The closing date for applications is 1st February 2025
We are unable to consider late applications.
Thrombosis UK has a strict data protection policy that complies with UK data protection law.
Your name and contact details may be stored for up to 12 months in order for correspondence relating to your application be appropriately processed.
We wish to make you aware that your name and contact details, as included on your completed application form, will be viewed by the Thrombosis UK appointed Judging Panel solely for the purpose of reviewing and assessing your completed application. If your nomination is short listed, a representative from Thrombosis UK will then seek your permission to include your name on the summary paragraph included in the awards brochure and on the Thrombosis UK website.
Thrombosis UK takes security and confidentiality very seriously. Your name and contact details will never be passed or shared with any third party or an unauthorised individual. If you have any queries, please contact: [email protected]
