Mechanical restraint linked to small increased short-term blood clot risk in psychiatric hospitals

Mechanical restraint is associated with a small increased short-term risk of blood clots among inpatients at psychiatric hospitals, finds a Danish study published by The BMJ. Although the absolute risk remains very low, the researchers say the findings support ongoing preventive efforts to reduce the use of mechanical restraint.

People with severe mental illness have an increased risk of blood clots, known as venous thromboembolism (VTE), likely due to several risk factors, including existing physical illness and lifestyle factors such as smoking and inactivity.

Where inpatients in psychiatric hospitals are at imminent risk of harming themselves or others, mechanical restraint may be necessary. It typically involves the use of a waist belt and, more rarely, wrist or ankle straps.

Mechanical restraint may increase the risk of VTE due to immobility—a known risk factor. But evidence on the size of this potential risk is limited. The researchers therefore set out to examine the short-term risk of VTE following mechanical restraint among inpatients at psychiatric hospitals.

Their findings are based on 24,423 patients ages 18 and older who were admitted to a psychiatric hospital in Denmark between January 2000 and September 2022 and were exposed to either mechanical or chemical restraint (use of sedative medication).

A range of potentially influential factors such as age, sex, marital status, education level, admission diagnosis, medication history and time from admission to mechanical or chemical restraint were taken into account.

A total of 10,208 patients were exposed to mechanical restraint during the study period (median age 40; 68% men). Mechanical restraint was associated with a twofold higher 30-day risk of VTE (3.5 per 1,000 patients in the mechanical restraint group compared with 1.7 per 1,000 patients in the chemical restraint group).

If the observed link between mechanical restraint and VTE risk is causal, the researchers estimate that there will be one additional VTE for every 548 people subjected to restraint.

This is an observational study, so no firm conclusions can be drawn about cause and effect, and the researchers cannot rule out the possibility that other unmeasured factors, such as smoking and body weight, may have influenced their results.

However, they minimized bias by including data from all Danish psychiatric hospitals, providing greater confidence in their conclusions.

As such, they conclude, “Mechanical restraint was associated with an elevated risk of VTE. Although the absolute risk was low, these findings highlight the importance of preventive strategies to reduce the risk of VTE in patients exposed to mechanical restraint.”

In a linked editorial, researchers say restraint may be a modifiable risk factor, but more robust estimates of baseline risk are needed.

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Sadie Harley

BSc Life Sciences & Ecology. Microbiology lab background with pharmaceutical news experience in oil, gas, and renewable industries.

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Robert Egan

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