Venous Thromboembolism as a Forgotten Complication of Physical Restraint: A Scoping Review and Implications for Practice

Abstract

This scoping review explores and synthesizes the literature on thromboembolic events in physically restrained patients in mental healthcare settings, focusing on patient characteristics, associated risk factors, and treatment strategies. Following PRISMA-ScR guidelines, PubMed and Scopus were searched through September 2025 for studies reporting thromboembolic events in patients subjected to physical restraint in psychiatric settings. Two reviewers independently performed study selection and data extraction regarding patient profiles, restraint configurations, and preventive strategies. Evidence was synthesized descriptively without formal risk-of-bias assessment. Of 142 records identified, 20 studies (2001–2025) were included: 7 case reports, 3 case series, 6 case–control, and 4 cohort studies. Populations ranged from adolescents to older adults, primarily with schizophrenia or mood disorders. The incidence of thromboembolic events in cohort studies was 9% to 11%. Technical documentation was heterogeneous; 50% of studies did not report on the management of hydration, nutrition, or elimination. Six studies found an association between restraint and thromboembolic events, with prolonged duration most consistently implicated. Thromboprophylaxis was inconsistently described: 4 studies reported its use, 4 reported its absence, and 12 provided no information. Thromboembolic events are a preventable complication of physical restraint. Current evidence is limited by retrospective designs and fragmented reporting. Improving clinical safety requires standardized risk assessment and nursing-led somatic monitoring integrated with interdisciplinary support. Protocols tailored to these immobilization episodes are required to ensure behavioural stabilization does not compromise physiological safety.