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Semin Thromb Hemost 2025; 51(04): 430-437
DOI: 10.1055/s-0044-1800968
Review Article

The Overlooked Risk of Venous Thromboembolism in Psychiatric Patients: Epidemiology, Pathophysiology, and Implications for Clinical Care

Giris Jacob
1   Internal Medicine, Sourasky Medical Center, Tel Aviv, Israel
2   Recanati Research Center, “Sourasky” Medical Center, Tel Aviv, Israel
3   Faculty of Medicine, University of Tel Aviv, Tel Aviv, Israel
,
Yoab Ocytil
1   Internal Medicine, Sourasky Medical Center, Tel Aviv, Israel
,
Benjamin Brenner
4   Department of Hematology, Rambam Health Care Campus, Haifa, Israel
5   Faculty of Medicine, Technion Institute of Technology, Haifa, Israel
› Author Affiliations Funding The authors have received funding from Jacob Recanati Research Funding, NYC, United States and Tel Aviv, Israel.
› Further Information
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Abstract

Psychiatric patients face a significantly shorter life expectancy than the general population due to a complex interplay of medical, behavioral, and social factors. Venous thromboembolism (VTE), encompassing both pulmonary embolism and deep vein thrombosis, is an underrecognized yet critical contributor to morbidity and mortality in this population. Evidence suggests a two to three times higher prevalence of VTE in psychiatric patients compared to the general population, with incidence rates up to 4.5 per 1,000 person-years. This elevated risk is attributed to a hypercoagulable-hypofibrinolytic state. It is influenced by metabolic abnormalities, pro-inflammatory pathways, antipsychotic medications, and genetic factors. Health care biases and reduced treatment compliance further exacerbate the burden. This review explores the epidemiology, pathophysiology, and mechanistic underpinnings of VTE in psychiatric populations, emphasizing the role of metabolic syndrome and antipsychotic therapy. To mitigate mortality and enhance outcomes for these high-risk individuals, it is imperative to address this issue through improved risk stratification and preventive strategies.

Keywords

psychiatric diseases - venous thromboembolism - hypercoagulability - metabolic syndrome - antipsychotic drugs


Publication History

Article published online:
13 December 2024

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