From the AP-HP, GH Henri Mondor (Kowal), Service de pharmacie, Créteil; AP-HP, Hôpital universitaire Robert Debré (Peyre), Service de pédopsychiatrie, Paris; AP-HP, DMU IMPACT, GH Henri Mondor (Pelissolo, Leboyer, Schürhoff, Pignon), Service de Psychiatrie; Inserm, U955, team 15 (Pelissolo, Leboyer, Schürhoff, Pignon); Fondation FondaMental (Pelissolo, Leboyer, Schürhoff, Pignon); UPEC, Université Paris-Est Créteil Faculté de médecine (Pelissolo, Leboyer, Schürhoff, Pignon), Créteil; Univ. Lille, CNRS UMR 9193-PsyCHIC-SCALab, and CHU Lille (Amad), Pôle de Psychiatrie, Unité CURE; Fédération régionale de recherche en santé mentale (F2RSM) Hauts-de-France (Amad), Lille, France; and Institute of Psychiatry, Psychology and Neuroscience (Amad), College London, London, United Kingdom.
Psychosom Med. 2020 Nov/Dec;82(9):838-849. doi: 10.1097/PSY.0000000000000863.
Several studies have shown that psychiatric disorders can be associated with venous thromboembolism (VTE) risk, that is, pulmonary embolism (PE) and/or deep vein thrombosis (DVT). In this study, we provide a systematic review and meta-analyses of the studies addressing this issue.
All studies addressing the risk of VTE phenomena (whole VTE, PE, DVT, fatal VTE) in individuals with psychotic, mood, and anxiety disorders published between 1998 and 2019 were reviewed and included in the meta-analyses. Main characteristics of the studies and data concerning VTE risk were extracted. The methodological qualities of the studies were also analyzed. A random-effects meta-analysis model was used. A meta-analysis was conducted separately for each disorder, as well as separately for unadjusted and adjusted studies. Meta-analyses were repeated considering only good-quality studies. Heterogeneity was assessed.
Sixteen studies were reviewed and 15 included in the meta-analyses. Psychotic and bipolar disorders were significantly associated with VTE risk (VTE, DVT, PE, and fatal VTE for psychotic disorder: odds ratios [ORs] between 1.29 and 2.20; VTE, DVT, and PE for bipolar disorder: ORs between 1.22 and 2.14). Depression and anxiety disorders were associated with VTE risk only in adjusted analyses (DVT and PE for depression: ORs = 1.29; VTE and PE for anxiety disorders: ORs between 1.14 and 1.49).
The risk of VTE among individuals with psychiatric disorders may be explained by hypercoagulability and stasis, with both being related to, and independent of, treatment adverse effects. VTE risk should be taken into consideration in the treatment for people with psychiatric disorders.
多项研究表明，精神障碍可能与静脉血栓栓塞症（VTE）风险相关，即肺栓塞（PE）和/或深静脉血栓形成（DVT）。在本研究中，我们对解决这一问题的研究进行了系统评价和荟萃分析。
综述了 1998 年至 2019 年间发表的关于精神分裂症、心境障碍和焦虑症患者 VTE 现象（全 VTE、PE、DVT、致命性 VTE）风险的所有研究，并将其纳入荟萃分析。提取研究的主要特征和 VTE 风险数据。还分析了研究的方法学质量。使用随机效应荟萃分析模型。分别对每种疾病进行荟萃分析，以及对未调整和调整后的研究分别进行荟萃分析。仅考虑高质量研究进行了重复荟萃分析。评估了异质性。
共综述了 16 项研究，其中 15 项纳入荟萃分析。精神分裂症和双相障碍与 VTE 风险显著相关（精神分裂症：VTE、DVT、PE 和致命性 VTE 的比值比 [OR]在 1.29 至 2.20 之间；双相障碍：VTE、DVT 和 PE 的 OR 在 1.22 至 2.14 之间）。仅在调整分析中，抑郁和焦虑障碍与 VTE 风险相关（DVT 和 PE 与抑郁：OR=1.29；VTE 和 PE 与焦虑障碍：OR 在 1.14 至 1.49 之间）。
精神障碍患者 VTE 风险可能与高凝状态和停滞相关，两者均与治疗不良事件相关且独立于其相关。在治疗精神障碍患者时，应考虑 VTE 风险。
