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Venous thromboembolism prophylaxis – beware of potential risks

Published online by Cambridge University Press:  02 January 2018

Rashmi K. Patel*
Department of Psychosis Studies, King's College London, email:
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This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (, which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
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, Reference Wang, Honeycutt, Tapson, Moll, Granger and Ohman2 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. Reference Lederle, Zylla, Macdonald and Wilt3 Further evidence should be sought before such VTE prevention strategies are widely implemented in mental healthcare settings, lest they lead to patient harm.


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.Google Scholar
2 Wang, TY, Honeycutt, EF, Tapson, VF, Moll, S, Granger, CB, Ohman, EM. Incidence of thrombocytopenia among patients receiving heparin venous thromboembolism prophylaxis. Am J Med 2012; 125: 1214–21.Google Scholar
3 Lederle, FA, Zylla, D, Macdonald, R, Wilt, TJ. Venous thromboembolism prophylaxis in hospitalized medical patients and those with stroke: a background review for an American College of Physicians Clinical Practice Guideline. Ann Intern Med 2011; 155: 602–15.CrossRefGoogle ScholarPubMed
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