Khalid Ashna, Khalid Aafreen, Waite Sue, Plevin David
Central Adelaide Local Health Network, The Queen Elizabeth Hospital, Woodville, SA, Australia.
Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia.
Aust N Z J Psychiatry. 2025 Jan;59(1):8-17. doi: 10.1177/00048674241278235. Epub 2024 Sep 9.
Electroconvulsive therapy is an effective treatment for several psychiatric conditions. There are theoretical risks associated with electroconvulsive therapy in patients who are anticoagulated. However, there is no review investigating these adverse effects.
This systematic review explored the literature on using electroconvulsive therapy in anticoagulated patients, including adverse effects associated with continuation or cessation of anticoagulation during electroconvulsive therapy.
The study was registered on PROSPERO (registration CRD42023432178). A search was conducted across CENTRAL, Embase, Medline and PsychINFO databases, with title and abstract screening, full-text review and data extraction by two independent reviewers. Patients planned for electroconvulsive therapy and on anticoagulation prior to electroconvulsive therapy were included. Papers not related to electroconvulsive therapy or anticoagulation were excluded. Data were recorded in Microsoft Excel, presented in tables.
The studies comprised 108 patients and over 700 sessions of electroconvulsive therapy. 64.81% patients were on warfarin, 22.22% on a direct-acting oral anticoagulant, 5.55% on heparin and the rest on enoxaparin, dalteparin, acenocoumarol or bemiparin. There were two reports of both nonfatal non-central nervous system bleeding and pulmonary embolism in patients with anticoagulation. There were no intracranial haemorrhages or deaths. Bridging or substitution with an anticoagulant with a shorter half-life had no additional benefit.
This review showed tolerability of anticoagulants continued throughout electroconvulsive therapy, with most patients reporting no adverse effects. Given limitations including few studies and medical comorbidities influencing patient risk profile, further studies are required to guide practice recommendations and review long-term outcomes.
电休克治疗是几种精神疾病的有效治疗方法。对于接受抗凝治疗的患者，电休克治疗存在理论上的风险。然而，尚无综述研究这些不良反应。
本系统综述探讨了在接受抗凝治疗的患者中使用电休克治疗的相关文献，包括电休克治疗期间继续或停止抗凝治疗相关的不良反应。
该研究已在PROSPERO（注册号CRD42023432178）上注册。对CENTRAL、Embase、Medline和PsychINFO数据库进行了检索，由两名独立的评审员进行标题和摘要筛选、全文评审及数据提取。纳入计划接受电休克治疗且在电休克治疗前接受抗凝治疗的患者。排除与电休克治疗或抗凝治疗无关的论文。数据记录在Microsoft Excel中，并以表格形式呈现。
这些研究共纳入108例患者，进行了700多次电休克治疗。64.81%的患者使用华法林，22.22%的患者使用直接口服抗凝剂，5.55%的患者使用肝素，其余患者使用依诺肝素、达肝素、醋硝香豆素或苄丙酮香豆素。有两份报告称接受抗凝治疗的患者出现非致命性非中枢神经系统出血和肺栓塞。未发生颅内出血或死亡。用半衰期较短的抗凝剂进行桥接或替代并无额外益处。
本综述表明，在整个电休克治疗过程中持续使用抗凝剂具有耐受性，大多数患者未报告不良反应。鉴于研究数量较少以及影响患者风险状况的医疗合并症等局限性，需要进一步研究以指导实践建议并评估长期结果。
