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Yan Y, Wang L, Yuan Y, Xu J, Chen Y, Wu B. A pharmacovigilance study of the association between antipsychotic drugs and venous thromboembolism based on Food and Drug Administration Adverse Event Reporting System data. Expert Opin Drug Saf 2024; 23:771-776. [PMID: 37615268 DOI: 10.1080/14740338.2023.2251881] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 08/09/2023] [Indexed: 08/25/2023]
Abstract
BACKGROUND This study aimed to measure and present a comprehensive overview of the association of antipsychotic drugs and venous thromboembolism (VTE) in the Food and Drug Administration Adverse Event Reporting System (FAERS). Method: All VTE cases treated with antipsychotic drugs as primary suspected medicines were extracted from the FAERS database from 2004 to 2021. Disproportionality analyses were conducted by estimating the reporting odds ratio (ROR) and the information component (IC). RESULTS In the FAERS system, 4,455 VTE cases associated with antipsychotics were identified. The VTE signal was detected with olanzapine, haloperidol, paliperidone, and quetiapine. The RORs and 95% confidence intervals (95% CI) of olanzapine, haloperidol, paliperidone, and quetiapine were (ROR = 2.53 95% Cl 2.38-2.69 IC = 1.31 95% Cl 1.11-1.52), (ROR = 2.17 95% Cl 1.91-2.46 IC = 1.1 95% Cl 0.66-1.52), (ROR = 1.6 95% Cl 1.4-1.83 IC = 0.67 95% Cl 0.22-1.11), and (ROR = 1.37 95% Cl 1.28-1.47 IC = 0.45 95% Cl 0.23-0.67). Pulmonary embolism occurred in more than 50% of VTE events (2760 cases, 52.84%). CONCLUSION The data mining of FAERS suggested an association between VTE and antipsychotic drugs, which reminds medical workers to pay attention to the serious adverse drug effects of antipsychotic drugs leading to venous thromboembolism.
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Affiliation(s)
- Yu Yan
- Department of Pharmacy, West China Hospital, Sichuan University, Chengdu, China
- West China College of Pharmacy, Sichuan University, Chengdu, China
| | - Ling Wang
- West China College of Pharmacy, Sichuan University, Chengdu, China
| | - Yanling Yuan
- Department of Pharmacy, West China Hospital, Sichuan University, Chengdu, China
| | - Jiayue Xu
- Department of Pharmacy, West China Hospital, Sichuan University, Chengdu, China
| | - Yuxian Chen
- Department of Pharmacy, West China Hospital, Sichuan University, Chengdu, China
| | - Bin Wu
- Department of Pharmacy, West China Hospital, Sichuan University, Chengdu, China
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Dho-Nagy EA, Brassai A, Lechsner P, Ureche C, Bán EG. COVID-19 and Antipsychotic Therapy: Unraveling the Thrombosis Risk. Int J Mol Sci 2024; 25:818. [PMID: 38255892 PMCID: PMC10815664 DOI: 10.3390/ijms25020818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 01/04/2024] [Accepted: 01/04/2024] [Indexed: 01/24/2024] Open
Abstract
In the context of the COVID-19 pandemic, this study investigates the potential correlation between the increased use of antipsychotic medications and the rising incidence of venous thromboembolism (VTE). As psychiatric disorders surged, the consequential escalation in antipsychotic drug use raised concerns about thrombotic risks. We conducted a comprehensive literature review using PubMed, focusing on articles that intersected COVID-19, antipsychotic medication, and thrombosis. This approach allowed for a nuanced examination of the historical and recent data on antipsychotic drugs and their association with thrombotic events. Our findings reveal a notable link between the use of antipsychotic medications, particularly second-generation antipsychotics, and an increased risk of VTE, including pulmonary embolism and deep vein thrombosis. This association was evident, despite variations in study designs and populations. The study underscores the need for cautious medication management in psychiatric care, especially during pandemic conditions like COVID-19, to mitigate thrombotic risks. It advocates a personalized approach to prescribing antipsychotics, considering individual patient factors and comorbidities, to balance the benefits against potential thrombotic complications.
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Affiliation(s)
- Eszter-Anna Dho-Nagy
- Department of Pharmacology and Clinical Pharmacology, Faculty of Medicine in English, Preclinical Research Laboratory, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540142 Targu Mures, Romania
| | - Attila Brassai
- Department of Pharmacology and Clinical Pharmacology, Faculty of Medicine in English, Preclinical Research Laboratory, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540142 Targu Mures, Romania
| | - Patrick Lechsner
- Department of Pharmacology and Clinical Pharmacology, Faculty of Medicine in English, Preclinical Research Laboratory, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540142 Targu Mures, Romania
| | - Corina Ureche
- Department of Internal Medicine, Faculty of Medicine, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540142 Targu Mures, Romania
| | - Erika-Gyöngyi Bán
- Department of Pharmacology and Clinical Pharmacology, Faculty of Medicine in English, Preclinical Research Laboratory, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540142 Targu Mures, Romania
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Dai L, Zuo Q, Chen F, Chen L, Shen Y. The Association and Influencing Factors between Antipsychotics Exposure and the Risk of VTE and PE: A Systematic Review and Meta-analysis. Curr Drug Targets 2021; 21:930-942. [PMID: 32321400 DOI: 10.2174/1389450121666200422084414] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 02/20/2020] [Accepted: 02/21/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Different clinical studies have given inconsistent results on whether the use of antipsychotics increases the risk of thromboembolism. In this paper, we reviewed all relevant literature to provide suggestions for clinical diagnosis and treatment. METHODS PubMed, Web of Science, EMBASE, MEDLINE, Cochrane and Scopus databases were thoroughly searched up to June 2019. Two researchers independently searched the literature, extracted data. Data were analyzed by Stata 12.0 software. RESULTS A total of 22 studies involving 31514226 subjects were included. This meta-analysis showed that patients taking the first- or second-generation antipsychotics had a higher risk of venous thromboembolism and pulmonary embolism than those who did not, and low potency first-generation agents increased the risk of venous thromboembolism more than high potency antipsychotics, and olanzapine, clozapine, haloperidol, perphenazine and risperidone also significantly increased the risk of it. The risk of venous thrombosis in obese people was higher than that in overweight people, patients not less than 65 years old had an increased risk compared with younger patients. In addition, women taking antipsychotics had a higher risk of pulmonary embolism than men. CONCLUSION The use of antipsychotics will increase the risk of venous thromboembolism and pulmonary embolism, which will be affected by the type of antipsychotics and patient characteristics.
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Affiliation(s)
- Luqi Dai
- Department of Respiratory and Critical Care Medicine, West China Hospital, West China School of Medicine, Sichuan University, Chengdu, Sichuan 610041, China
| | - Qiunan Zuo
- Department of Geriatric Respiratory Medicine, Sichuan Academy of Medical Sciences, Sichuan Provincial People's Hospital, Chengdu, Sichuan 610072, China
| | - Fangying Chen
- Department of Tuberculosis, the Third People's Hospital of Tibet Autonomous Region, Lhasa 850000, China
| | - Lei Chen
- Department of Respiratory and Critical Care Medicine, West China Hospital, West China School of Medicine, Sichuan University, Chengdu, Sichuan 610041, China
| | - Yongchun Shen
- Department of Respiratory and Critical Care Medicine, West China Hospital, West China School of Medicine, Sichuan University, Chengdu, Sichuan 610041, China
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Di X, Chen M, Shen S, Cui X. Antipsychotic use and Risk of Venous Thromboembolism: A Meta-Analysis. Psychiatry Res 2021; 296:113691. [PMID: 33421839 DOI: 10.1016/j.psychres.2020.113691] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 12/24/2020] [Indexed: 12/26/2022]
Abstract
OBJECTIVE This study aimed to evaluate the association between antipsychotic drugs (APs) and the risk of venous thromboembolism (VTE). METHODS We searched Pubmed, Embase, and the Cochrane Library from inception to August 15, 2019 for case-control studies and cohort studies that explored the association between APs and VTE. Two researchers independently screened the literature, extracted the data and evaluated the bias risk included in the study. Meta-analysis was carried out by using STATA 13.0. RESULTS 1,468 studies were identified through database search, and 22 studies were finally included (14 case-control studies and 8 cohort studies). Overall, the APs usage was associated with increased risk of VTE and pulmonary embolism (PE) with no publication bias. Both the first-generation APs (FGAs) and second-generation APs (SGAs) can increased the risk of VTE. The low-potency FGAs lead to a higher risk of VTE than high-potency FGAs. The risk of PE and VTE in younger patients was about 3-fold higher compared with elderly. CONCLUSION This review demonstrates that APs usage can increase the risk of VTE. Young people are at a higher risk of VTE than elderly when taking APs.
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Affiliation(s)
- Xuan Di
- Department of Pharmacy, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Muyi Chen
- Department of Pharmacy, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Su Shen
- Department of Pharmacy, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Xiangli Cui
- Department of Pharmacy, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China.
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Liu Y, Xu J, Fang K, Xu Y, Gao J, Zhou C, Tang X, Fang X, Chen J, Xie C, Zhang F, Zhang X, Wang C. Current antipsychotic agent use and risk of venous thromboembolism and pulmonary embolism: a systematic review and meta-analysis of observational studies. Ther Adv Psychopharmacol 2021; 11:2045125320982720. [PMID: 33505665 PMCID: PMC7812411 DOI: 10.1177/2045125320982720] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 10/19/2020] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Antipsychotic agents (APS) are widely used drugs to treat psychotic symptoms and can effectively reduce both positive and negative symptoms of schizophrenia. For decades, some studies suggested that there is a relationship between using APS and the risk of venous thromboembolism (VTE) and pulmonary embolism (PE). However, results remain inconclusive. METHOD This review has been registered in International Prospective Register of Systematic Reviews (PROSPERO, ID: CDR42020155620). Relevant studies were identified among observational studies published up to 1 October 2019 in the databases MEDLINE, EMBASE, and Cochrane Library. Random or fixed-effects models were used to calculate the pooled odds ratio (OR). RESULTS In total, 28 observational studies were included. The results showed that compared with non-users, current APS users have significantly increased risks of VTE [OR 1.55 95% confidence interval (CI) 1.36, 1.76] and PE (OR 3.68, 95% CI 1.23, 11.05). Subgroup analyses suggested that new users were associated with a higher risk of VTE (OR 2.06, 95% CI 1.81, 2.35). For individual drugs, increased risk of VTE and PE was observed in taking haloperidol, risperidone, olanzapine, prochlorperazine but not in chlorpromazine, quetiapine or aripiprazole. However, careful interpretation is needed because of high heterogeneity among studies and scarce data. CONCLUSION The present comprehensive meta-analysis further indicates a significantly increased risk of VTE and PE in current APS users compared with non-users. Subgroup analyses suggest that new users are more likely to develop VTE. However, due to significant heterogeneity among studies, conclusions should be considered with caution.
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Affiliation(s)
- Yinzhao Liu
- Department of Geriatric Psychiatry, Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu, China
| | - Jun Xu
- Department of Geriatric Psychiatry, Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu, China
| | - Kacey Fang
- Department of Cognitive Science, Yale University, New Haven, CT, USA
| | - Yue Xu
- Department of Geriatric Psychiatry, Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu, China
| | - Ju Gao
- Department of Geriatric Psychiatry, Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu, China
| | - Chao Zhou
- Department of Geriatric Psychiatry, Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu, China
| | - Xiaowei Tang
- Department of Geriatric Psychiatry, Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu, China
| | - Xinyu Fang
- Department of Geriatric Psychiatry, Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu, China
| | - Jiu Chen
- Institute of Neuropsychiatry, the Affiliated Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Chunming Xie
- Department of Neurology, Affiliated ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Fuquan Zhang
- Department of Geriatric Psychiatry, Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu, China
| | - Xiangrong Zhang
- Department of Geriatric Psychiatry, Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Congjie Wang
- Department of Psychiatry, Huai'an No. 3 People's Hospital, Huai'an 223001, Jiangsu, China
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Arasteh O, Nomani H, Baharara H, Sadjadi SA, Mohammadpour AH, Ghavami V, Sathyapalan T, Sahebkar A. Antipsychotic Drugs and Risk of Developing Venous Thromboembolism and Pulmonary Embolism: A Systematic Review and Meta-Analysis. Curr Vasc Pharmacol 2020; 18:632-643. [DOI: 10.2174/1570161118666200211114656] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 01/30/2020] [Accepted: 01/31/2020] [Indexed: 01/20/2023]
Abstract
Background:Antipsychotic (AP) medications are the cornerstone treatment for schizophrenia and some other psychiatric diseases. However, some observational studies suggest that these medications might increase the risk of venous thromboembolism (VTE) and pulmonary embolism (PE).Objectives:The aim of this study was to assess whether AP medications are associated with the development of VTE or PE, and to assess the risk based on any type of AP drugs, quality of studies and after adjustment of risk factors.Data sources:To identify relevant studies, we searched PubMed and EMBASE databases up to February 2019. We also searched the reference lists of relevant articles for related studies.Study Selection:Twenty studies fulfilled the eligibility criteria and were included in our meta-analysis after screening relevant observational cohort and case-control studies.Primary Outcome:The primary outcome of our meta-analysis was the occurrence of all VTE or PE only attributed to exposure to AP medications compared with non-exposure to AP medications.Results:Exposure to AP drugs was associated with a significant increase in the risk of VTE (RR 1.53, 95% CI 1.30-1.80, I2 = 85%) and PE (RR 3.69, 95% CI 1.23-11.07, I2 = 90%). In the subgroup metaanalysis, the use of low-potency AP drugs was associated with a higher risk of VTE, (RR 1.90, 95% CI 1.04-3.47, I2 = 78%).Conclusion:AP exposure was associated with a 1.5-fold increase in the risk of VTE and a 3.7-fold increase in the risk of PE. Low-potency AP drugs were associated with a higher risk of VTE. However, high heterogeneity among studies limits the generalizability of the results.
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Affiliation(s)
- Omid Arasteh
- Department of Clinical Pharmacy, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Homa Nomani
- Department of Clinical Pharmacy, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hamed Baharara
- Department of Clinical Pharmacy, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Seyed A. Sadjadi
- Department of Psychiatry, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Amir H. Mohammadpour
- Department of Clinical Pharmacy, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Vahid Ghavami
- Department of Biostatistics and Epidemiology, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Thozhukat Sathyapalan
- Department of Academic Diabetes, Endocrinology and Metabolism, Hull York Medical School, University of Hull, Hull HU3 2RW, United Kingdom
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Sheldon RR, Holtestaul TA, Morte DR, Jones IF, Forte DM, Bingham JR. Influence of preoperative psychotropic medications on opioid requirements and outcomes following bariatric surgery. Am J Surg 2020; 219:841-845. [DOI: 10.1016/j.amjsurg.2020.03.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 03/09/2020] [Accepted: 03/18/2020] [Indexed: 12/15/2022]
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Hoirisch-Clapauch S, Nardi AE. Antidepressants: bleeding or thrombosis? Thromb Res 2020; 181 Suppl 1:S23-S28. [PMID: 31477223 DOI: 10.1016/s0049-3848(19)30362-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 03/10/2019] [Accepted: 05/03/2019] [Indexed: 02/02/2023]
Abstract
The contribution of depression to the pathogenesis of cardiovascular disease includes autonomic disturbances, endothelial dysfunction, inflammation, smoking, sedentary lifestyle, carbohydrate craving, and impaired fibrinolysis. There is evidence that serotonergic antidepressants (selective serotonin reuptake inhibitors and serotonin and noradrenaline reuptake inhibitors) restore the fibrinolytic profile. Contrary to common belief, such antidepressants do not affect platelet aggregation induced by adenosine diphosphate or adrenaline but reduce platelet adhesion to collagen. Since platelet collagen receptor glycoprotein VI binds to fibrin, it is possible that fibrinolytic properties of serotonergic antidepressants could impair platelet adhesion to collagen. The profibrinolytic and antiplatelet properties of serotonergic antidepressants help explain the increased risk of gastrointestinal, intracranial, and surgical bleeding in patients using these medications. Studies evaluating the impact of antidepressants on thrombotic and cardiovascular risk have yielded contradictory results. Corroborating the hypothesis that serotonergic antidepressants have profibrinolytic and antiplatelet properties, some authors showed that these medications prevent both cardiovascular and thromboembolic events. Others showed an increased risk of ischemic stroke, cardiac events and thromboembolic disease. Silent brain infarction may present in some elders with depressive symptoms, so it is presumed that antidepressants are prescribed for subclinical stroke patients. Another explanation for the increased risk of cardiovascular and thromboembolic events reported by some authors in individuals taking antidepressants includes antidepressant side effects such as sedation and weight gain and depression comorbidities such as anxiety, obesity and hyperhomocysteinemia. In conclusion, we suggest that serotonergic antidepressants be considered weak anticoagulants. We also suggest that depressed patients with comorbidities increasing the risk of cardiovascular and thromboembolic disease be recommended to follow a balanced diet and engage in physical activity, such as daily walking.
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Affiliation(s)
| | - Antonio E Nardi
- Institute of Psychiatry, Federal University of Rio de Janeiro, Brazil
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Kowal C, Peyre H, Amad A, Pelissolo A, Leboyer M, Schürhoff F, Pignon B. Psychotic, Mood, and Anxiety Disorders and Venous Thromboembolism: A Systematic Review and Meta-Analysis. Psychosom Med 2020; 82:838-849. [PMID: 32947580 DOI: 10.1097/psy.0000000000000863] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE 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. METHODS 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. RESULTS 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). CONCLUSIONS 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.
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Affiliation(s)
- Célia Kowal
- 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
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10
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Rarrick C, Saccone N, Hebbard A, Jones B. Assessing the Rate of Antipsychotic Use in Ambulatory Care Patients With a Venous Thromboembolism. Ann Pharmacother 2019; 54:97-104. [PMID: 31416330 DOI: 10.1177/1060028019870874] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Evidence regarding the use of antipsychotics and associated venous thromboembolism (VTE) risk is inconclusive. Studies finding a relationship lack in-depth analysis; thus, the VTE risk among those treated with antipsychotic remains largely unknown. Objectives: The primary objective of this investigation was to compare the incidence of antipsychotic use in patients who developed a VTE versus those who did not. Methods: Data were collected via retrospective chart review from an ambulatory care clinic between January 2012 and August 2017. All active clinic patients within the study period were included unless they met the following criteria: age <18 years, pregnancy within the study period, and/or current or historical malignancy. The odds ratio (OR) of developing a VTE was determined using multivariate regression analysis controlling for age, gender, obesity, and smoking. Secondary end points were reviewed for participants who were exposed to an antipsychotic and subsequently developed a VTE within the study period. Results: A total of 7079 patients were included in the analysis, of whom 314 developed a VTE. Of these, 45 were exposed to an antipsychotic prior to VTE development. Nearly 25% of patients receiving an antipsychotic did not have a primary psychiatric diagnosis. Results suggest that antipsychotic use was significantly associated with increased risk of VTE development (OR = 1.481 [95% CI = 1.067 to 2.055]). Conclusion and Relevance: The results of this study suggest an association between antipsychotic use and VTE development. This association should be considered when prescribing antipsychotics and treating patients who develop a VTE after antipsychotic exposure.
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Affiliation(s)
| | - Nicole Saccone
- Medical University of South Carolina (MUSC), Charleston, SC, USA
| | - Amy Hebbard
- Medical University of South Carolina (MUSC), Charleston, SC, USA
| | - Brittany Jones
- Medical University of South Carolina (MUSC), Charleston, SC, USA
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11
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Ellis N, Grubb CM, Mustoe S, Watkins E, Codling D, Fitch S, Stirland L, Quraishy M, Jenkinson J, Harrison J. Venous thromboembolism risk in psychiatric in-patients: a multicentre cross-sectional study. BJPsych Bull 2019; 43:255-259. [PMID: 31030692 DOI: 10.1192/bjb.2019.25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aims and methodWe assessed venous thromboembolism (VTE) risk, barriers to prescribing VTE prophylaxis and completion of VTE risk assessment in psychiatric in-patients. This was a cross-sectional study conducted across three centres. We used the UK Department of Health VTE risk assessment tool which had been adapted for psychiatric patients. RESULTS: Of the 470 patients assessed, 144 (30.6%) were at increased risk of VTE. Patients on old age wards were more likely to be at increased risk than those on general adult wards (odds ratio = 2.26, 95% CI 1.51-3.37). Of those at higher risk of VTE, auditors recorded concerns about prescribing prophylaxis in 70 patients (14.9%). Only 20 (4.3%) patients had a completed risk assessment.Clinical implicationsMental health in-patients are likely to be at increased risk of VTE. VTE risk assessment is not currently embedded in psychiatric in-patient care. There is a need for guidance specific to this population.Declaration of interestNone.
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12
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Impact of drugs on venous thromboembolism risk in surgical patients. Eur J Clin Pharmacol 2019; 75:751-767. [DOI: 10.1007/s00228-019-02636-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 01/21/2019] [Indexed: 01/14/2023]
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13
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Almegren M. Pulmonary embolism in a patient with neuroleptic malignant syndrome. Hematol Rep 2018; 10:7753. [PMID: 30631408 PMCID: PMC6297863 DOI: 10.4081/hr.2018.7753] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 11/16/2018] [Indexed: 11/24/2022] Open
Abstract
Venous thromboembolism is one of the complications in patients prescribed antipsychotic medications. Neuroleptic malignant syndrome (NMS) is a rare side effect of antipsychotic medications in this population. In this case, a young patient, who presented with NMS after a recent start of antipsychotic medications, had developed a pulmonary embolism despite standard of care measures of venous thromboprophylaxis and early mobilization. A low threshold of VTE suspicion and effective preventive measures are both required in order to avoid this preventable complication in this population.
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Affiliation(s)
- Mosaad Almegren
- Department of Medicine, Al Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
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14
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Kunutsor SK, Seidu S, Khunti K. Depression, antidepressant use, and risk of venous thromboembolism: systematic review and meta-analysis of published observational evidence. Ann Med 2018; 50:529-537. [PMID: 30001640 DOI: 10.1080/07853890.2018.1500703] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
PURPOSE Evidence on the association between depression, antidepressant use and venous thromboembolism (VTE) risk is conflicting. We conducted a systematic review and meta-analysis of published observational studies evaluating the associations of depression and antidepressant use with VTE risk. DESIGN Eligible studies were identified in a literature search of MEDLINE, Embase, Web of Science and reference list of relevant studies up to April 2018. Pooled relative risks (RRs) with 95% confidence intervals (CIs) were aggregated using random effects models. RESULTS Eight observational studies with data on 960 113 nonoverlapping participants and 9027 VTE cases were included. The pooled RR (95% CI) for VTE comparing antidepressant use with no antidepressant use was 1.27 (1.06-1.51). Tricyclic antidepressants, selective serotonin reuptake inhibitors and other antidepressants were each associated with an increased VTE risk; 1.16 (1.06-1.27), 1.12 (1.02-1.23), and 1.59 (1.21-2.09), respectively. In pooled analysis of three studies that compared patients with depression versus individuals without depression, the RR for VTE was 1.31 (1.13-1.53). CONCLUSIONS Pooled observational evidence suggests that depression and use of antidepressants are each associated with an increased VTE risk. The effect of antidepressant drugs on VTE may be a class effect. The mechanistic pathways underlying these associations deserve further evaluation. Systematic review registration: PROSPERO 2018: CRD42018095595 Key messages Emerging evidence suggests that depression and antidepressant use may be associated with venous thromboembolism (VTE) risk, but the evidence is conflicting. This first systematic review and meta-analysis of observational studies shows that depression and use of antidepressants are each associated with an increased risk of VTE. There may be a class effect of antidepressant drugs on VTE.
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Affiliation(s)
- Setor K Kunutsor
- a National Institute for Health Research Bristol Biomedical Research Centre , University Hospitals Bristol NHS Foundation Trust and University of Bristol , Bristol , UK.,b Translational Health Sciences, Bristol Medical School, Musculoskeletal Research Unit , University of Bristol, Learning & Research Building (Level 1) , Southmead Hospital , Bristol , UK
| | - Samuel Seidu
- c Leicester Diabetes Centre, Leicester General Hospital , Leicester , UK.,d Diabetes Research Centre , University of Leicester, Leicester General Hospital , Leicester , UK
| | - Kamlesh Khunti
- c Leicester Diabetes Centre, Leicester General Hospital , Leicester , UK.,d Diabetes Research Centre , University of Leicester, Leicester General Hospital , Leicester , UK
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Antipsychotic drugs may increase the risk of venous thromboembolism. DRUGS & THERAPY PERSPECTIVES 2018. [DOI: 10.1007/s40267-018-0535-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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16
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Peippo MH, Kurki S, Lassila R, Carpén OM. Real-world features associated with cancer-related venous thromboembolic events. ESMO Open 2018; 3:e000363. [PMID: 30094068 PMCID: PMC6069925 DOI: 10.1136/esmoopen-2018-000363] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 05/30/2018] [Accepted: 06/02/2018] [Indexed: 11/26/2022] Open
Abstract
Background The incidence of venous thromboembolism (VTE) is 1–2/1000 individuals. Patients with cancer, especially during chemotherapy, are at enhanced risk, but real-world data on factors associated with VTE events are still scarce. Aim The aim of this retrospective study was to survey the incidence of VTE based on a large hospital database, and to identify comorbidities and features associated with VTE events. We focused on cancer-related VTE events and on factors indicating increased VTE risk during chemotherapy. Methods The cohort included patients treated at Turku University Hospital during years 2005–2013. Health information was derived and analysed from multiple electronic databases. The diagnoses of VTE and all comorbidities, including type of cancer, were based on International Classification of Diseases 10th Revision coding. For further analysis, we focused on 16 common types of cancers treated with chemotherapy. Age, gender, surgery, radiotherapy, distant metastasis, available laboratory values and platinum-based chemotherapy were evaluated for VTE group, and associations were estimated by Cox regression analyses. Results The entire database contained information from 495 089 patients, of whom 5452 (1.1%) had a VTE diagnosis. Among individuals with VTE, 1437 (26.4%) had diagnosis of coronary heart disease and 1467 (26.9%) had cancer diagnosis. Among 7778 patients with cancer treated with chemotherapy, 282 (3.6%) had a VTE, platinum-based chemotherapy being a major risk factor (HR 1.77, 95% CI 1.40 to 2.24, p<0.001). In multivariate analysis, elevated blood neutrophil counts (>3.25×109 cells/L, HR 1.96, 95% CI 1.33 to 2.89, p<0.001) and plasma creatinine (>62.5 μmol/L; HR 1.60, 95% CI 1.21 to 2.13, p=0.001) values were independent indicators of increased VTE risk during chemotherapy. Conclusions Longitudinal electronic health record analysis provides a powerful tool to gather meaningful real-world information to study clinical associations, like comorbidities, and to identify markers associated with VTE. The combination of various clinical and laboratory variables could be used for VTE risk evaluation and targeted prevention.
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Affiliation(s)
- Maija Helena Peippo
- Institute of Biomedicine, Research Center for Cancer, Infections and Immunity, University of Turku, Turku, Finland
| | - Samu Kurki
- Auria Biobank, University of Turku and Turku University Hospital, Turku, Finland
| | - Riitta Lassila
- Unit of Coagulation Disorders, Department of Hematology and Comprehensive Cancer Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Olli Mikael Carpén
- Genome Scale Biology Research Program and Department of Pathology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
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Jönsson AK, Schill J, Olsson H, Spigset O, Hägg S. Venous Thromboembolism During Treatment with Antipsychotics: A Review of Current Evidence. CNS Drugs 2018; 32:47-64. [PMID: 29423659 PMCID: PMC5843694 DOI: 10.1007/s40263-018-0495-7] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
This article summarises the current evidence on the risk of venous thromboembolism (VTE) with the use of antipsychotics. An increasing number of observational studies indicate an elevated risk of VTE in antipsychotic drug users. Although the use of certain antipsychotics has been associated with VTE, current data can neither conclusively verify differences in occurrence rates of VTE between first- and second-generation antipsychotics or between individual compounds, nor identify which antipsychotic drugs have the lowest risk of VTE. The biological mechanisms involved in the pathogenesis of this adverse drug reaction are still to be clarified but hypotheses such as drug-induced sedation, obesity, increased levels of antiphospholipid antibodies, enhanced platelet aggregation, hyperhomocysteinaemia and hyperprolactinaemia have been suggested. Risk factors associated with the underlying psychiatric disorder may at least partly explain the increased risk. Physicians should be aware of this potentially serious and even sometimes fatal adverse drug reaction and should consider discontinuing or switching the antipsychotic treatment in patients experiencing a VTE. Even though supporting evidence is limited, prophylactic antithrombotic treatment should be considered in risk situations for VTE.
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Affiliation(s)
- Anna K Jönsson
- Department of Drug Research, Section of Clinical Pharmacology, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
- Department of Forensic Genetics and Forensic Chemistry, National Board of Forensic Medicine, Linköping, Sweden
| | - Johan Schill
- Department of Psychiatry, Region Jönköping County, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Hans Olsson
- Department of Psychiatry, Region Jönköping County, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Olav Spigset
- Department of Clinical Pharmacology, St. Olav University Hospital, Trondheim, Norway
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Staffan Hägg
- Futurum, Region Jönköping County, Department of Medical and Health Sciences, Linköping University, Sweden.
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Gaertner S, Piémont A, Faller A, Bertschy G, Hallouche N, Mirea C, Le Ray I, Cordeanu EM, Stephan D. Incidence and risk factors of venous thromboembolism: Peculiarities in psychiatric institutions. Int J Cardiol 2017; 248:336-341. [DOI: 10.1016/j.ijcard.2017.07.092] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 06/23/2017] [Accepted: 07/26/2017] [Indexed: 01/26/2023]
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Liou JT, Huang YW, Lin C, Wu GJ, Chu CL, Yeh CB, Wang YH, Wang MT. Use of antipsychotics and risk of venous thromboembolism in postmenopausal women. Thromb Haemost 2017; 115:1209-19. [DOI: 10.1160/th15-11-0895] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2015] [Accepted: 02/20/2016] [Indexed: 01/24/2023]
Abstract
SummaryDespite continued uncertainty of venous thromboembolism (VTE) caused from antipsychotic agents, this safety issue has not been examined in postmenopausal women, a population with high usages of antipsychotics and at high risk for VTE. We assessed whether antipsychotic use was associated with an increased VTE risk in women after menopause. We conducted a nested case-control study of all Taiwanese women aged ≥ 50 years (n = 316,132) using a nationwide healthcare claims database between 2000 and 2011. All newly diagnosed VTE patients treated with an anticoagulant or thrombectomy surgery were identified as cases (n = 2,520) and individually matched to select controls (n = 24,223) by cohort entry date, age, cancer diagnosis and major surgery procedure. The odds ratios (ORs) and 95 % confidence interval (CI) of VTE associated with antipsychotics were estimated by multivariate conditional logistic regressions. Current use of antipsychotics was associated with a 1.90-fold (95 % CI = 1.64–2.19) increased VTE risk compared with nonuse in postmenopausal women. The VTE risk existed in a dose-dependent fashion (test for trend, p<0.001), with a more than quadrupled risk for high-dose antipsychotics (adjusted OR = 4.60; 95 % CI = 2.88–7.33). Current parenteral administration of antipsychotics also led to a 3.46-fold increased risk (95 % CI = 2.39–5.00). Conversely, there was no increased VTE risk when antipsychotics were discontinued for > 30 days. In conclusion, current use of antipsychotics is significantly associated with a dose-dependent increased risk of VTE in postmenopausal women, especially for those currently taking high-dose or receiving parenteral antipsychotics.
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Antipsychotic Use Among Adult Outpatients and Venous Thromboembolic Disease: A Retrospective Cohort Study. J Clin Psychopharmacol 2017. [PMID: 28622161 DOI: 10.1097/jcp.0000000000000738] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Treatment with antipsychotic (AP) agents is associated with incident thromboembolic events. However, the underpinnings of this association remain unknown. We sought to evaluate the effect of AP agents-categorized by their metabolic/sedative and hyperprolactinemia adverse effect profile-on the risk of venous thromboembolic disease during long-term follow-up. METHODS A retrospective cohort study of adult patients initiating AP treatment for the first time was conducted. Primary outcome was defined as the time to venous thromboembolism (VTE) (either deep venous thrombosis or acute pulmonary embolism). Antipsychotic agents were categorized by their risk (high vs low) of either drug-induced (a) sedation/metabolic adverse event or (b) hyperprolactinemia. We used a propensity score-adjusted Cox proportional hazards model to control for confounding. FINDINGS One thousand eight patients (mean age, 72.4 y) were followed for a median of 36 months. Incident VTE occurred in 6.25% of patients, corresponding to an incidence rate of 184 cases per 10,000 person-years. We found no difference in the hazard of VTE during follow-up between high- and low-risk groups (hazard ratio, 1.23 [95% confidence interval, 0.74-2.04] for drug-induced sedation/metabolic adverse event risk categories, and hazard ratio 0.81 [95% confidence interval, 0.50-1.35] for high versus low hyperprolactinemia risk). CONCLUSIONS These results suggest that the risk of thromboembolic events in older adults who started AP treatment for the first time does not seem to be related to these drugs' risk of either sedation/metabolic adverse events or hyperprolactinemia. However, VTE remains a common problem in this subgroup of patients.
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21
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Parkin L, Balkwill A, Sweetland S, Reeves GK, Green J, Beral V. Antidepressants, Depression, and Venous Thromboembolism Risk: Large Prospective Study of UK Women. J Am Heart Assoc 2017; 6:e005316. [PMID: 28515116 PMCID: PMC5524086 DOI: 10.1161/jaha.116.005316] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 03/21/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Some investigators have reported an excess risk of venous thromboembolism (VTE) associated with depression and with use of antidepressant drugs. We explored these associations in a large prospective study of UK women. METHODS AND RESULTS The Million Women Study recruited 1.3 million women through the National Health Service Breast Screening Programme in England and Scotland. Three years after recruitment, women were sent a second questionnaire that enquired about depression and regular use of medications in the previous 4 weeks. The present analysis included those who responded and did not have prior VTE, cancer, or recent surgery. Follow-up for VTE was through linkage to routinely collected National Health Service statistics. Cox regression analyses yielded adjusted hazard ratios and 95% CIs. A total of 734 092 women (mean age 59.9 years) were included in the analysis; 6.9% reported use of antidepressants, 2.7% reported use of other psychotropic drugs, and 1.8% reported being treated for depression or anxiety but not use of psychotropic drugs. During follow-up for an average of 7.3 years, 3922 women were hospitalized for and/or died from VTE. Women who reported antidepressant use had a significantly higher risk of VTE than women who reported neither depression nor use of psychotropic drugs (hazard ratio, 1.39; 95% CI, 1.23-1.56). VTE risk was not significantly increased in women who reported being treated for depression or anxiety but no use of antidepressants or other psychotropic drugs (hazard ratio, 1.19; 95% CI, 0.95-1.49). CONCLUSIONS Use of antidepressants is common in UK women and is associated with an increased risk of VTE.
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Affiliation(s)
- Lianne Parkin
- Cancer Epidemiology Unit, University of Oxford, United Kingdom
- Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Angela Balkwill
- Cancer Epidemiology Unit, University of Oxford, United Kingdom
| | - Siân Sweetland
- Cancer Epidemiology Unit, University of Oxford, United Kingdom
| | | | - Jane Green
- Cancer Epidemiology Unit, University of Oxford, United Kingdom
| | - Valerie Beral
- Cancer Epidemiology Unit, University of Oxford, United Kingdom
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Adelborg K, Sundbøll J, Videbech P, Grove EL. The Risk of Thromboembolism in Users of Antidepressants and Antipsychotics. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2016; 906:351-361. [DOI: 10.1007/5584_2016_125] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Guidelines for Disaster Medicine for Patients With Cardiovascular Diseases (JCS 2014/JSH 2014/JCC 2014) - Digest Version . Circ J 2015; 80:261-84. [PMID: 26632533 DOI: 10.1253/circj.cj-66-0121] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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24
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Jaros JA, Rahmoune H, Wesseling H, Leweke FM, Ozcan S, Guest PC, Bahn S. Effects of olanzapine on serum protein phosphorylation patterns in patients with schizophrenia. Proteomics Clin Appl 2015; 9:907-16. [PMID: 25821032 DOI: 10.1002/prca.201400148] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Revised: 01/14/2015] [Accepted: 03/10/2015] [Indexed: 12/23/2022]
Abstract
PURPOSE Previous studies have shown that blood serum phosphoproteins are altered in schizophrenia patients in comparison to controls. However, it is not known whether phosphoproteins are also changed in response to treatment with antipsychotics. EXPERIMENTAL DESIGN Blood samples were taken from patients (n = 23) at baseline and after 6 weeks of olanzapine treatment. Immobilized metal ion affinity chromatography (IMAC) was used for enrichment of serum phosphoproteins and these were analyzed by label-free LC-MS in expression mode (LC-MS(E) ). RESULTS We identified 11 proteins that were changed significantly in overall abundance and 45 proteins that showed changes in phosphorylation after the antipsychotic treatment. The altered phosphoproteins were mainly involved in the acute phase response, lipid and glucose homeostasis (LXR), retinoic acid signaling (RXR), and complement pathways. Some of the proteins showed a marked increase in phosphorylation, including apolipoprotein A-I (3.4-fold), alpha-1-anti-chymotrypsin (3.1-fold), and apolipoprotein B-100 (2.2-fold). In addition, several proteins showed either decreased phosphorylation (e.g. complement C4A, collagen alpha-1 chain, complement factor H) or a mixture of increased and decreased phoshphorylation (e.g. afamin, complement C5, complement factor B). Finally, 24 of the altered phosphoproteins showed opposite directional changes in a comparison of baseline schizophrenia patients before and after treatment with olanzapine. These included alpha-1B-glycoprotein, apolipoprotein A-IV, vitamin D-binding protein, and prothrombin. CONCLUSIONS AND CLINICAL RELEVANCE These data demonstrate the potential for future studies of serum phosphoproteins as a readout of physiological function and might have utility in studies aimed at identification of biomarkers for drug response prediction or monitoring.
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Affiliation(s)
- Julian A Jaros
- Department of Chemical Engineering and Biotechnology, University of Cambridge, Cambridge, UK
- Novartis Institutes of Biomedical Research (NIBR), Novartis Campus, Fabrikstrasse, Basel, Switzerland
| | - Hassan Rahmoune
- Department of Chemical Engineering and Biotechnology, University of Cambridge, Cambridge, UK
| | - Hendrik Wesseling
- Department of Chemical Engineering and Biotechnology, University of Cambridge, Cambridge, UK
| | - F Markus Leweke
- Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany
- Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Sureyya Ozcan
- Department of Chemical Engineering and Biotechnology, University of Cambridge, Cambridge, UK
| | - Paul C Guest
- Department of Chemical Engineering and Biotechnology, University of Cambridge, Cambridge, UK
| | - Sabine Bahn
- Department of Chemical Engineering and Biotechnology, University of Cambridge, Cambridge, UK
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Croxford A, Clare A, McCurdy K. Introduction of a Venous Thromboembolism Prophylaxis Protocol for Older Adult Psychiatric Patients. BMJ QUALITY IMPROVEMENT REPORTS 2015; 4:u205852.w3226. [PMID: 26734379 PMCID: PMC4645951 DOI: 10.1136/bmjquality.u205852.w3226] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Revised: 05/14/2015] [Indexed: 11/26/2022]
Abstract
Hospital-Acquired venous thromboembolism (VTE) is a common cause of morbidity and mortality in older adults. In psychiatric patients these risks are increased due to multiple factors including poor mobility, restraint, catatonia, sedation, and conventional antipsychotic use. Diagnosis and treatment of psychiatric patients presenting with signs and symptoms of a VTE can be delayed due to a patient's communication difficulties, non-compliance, or attribution of symptoms to a psychosomatic cause. However, despite the increased risk, approved VTE prophylaxis protocols are infrequently used on Psychiatric wards. On one Older Adult Psychiatric Ward, two patients presented with VTE (a fatal pulmonary embolism and a symptomatic deep vein thrombosis) over a 6 month period demonstrating the necessity for prophylactic assessment. A baseline audit over 3 months showed that 63-83% of patients on the ward had received no assessment of VTE risk, on any given week, although this improved slightly following the critical incidents. A VTE prophylaxis protocol, based on NICE guidance for VTE risk assessment in Medical and Surgical patients, was developed with consideration given to additional Psychiatric risk factors. This took the form of a pro-forma with a tick-box design that included mobility assessment, VTE risk factors, bleeding risk factors, and guidance on prescribing decisions. This was implemented on an Older Adult Psychiatric ward and prophylaxis was provided to those meeting the threshold. Weekly audit of all pro-formas (including assessments completed within 48 hours of admission and prophylaxis prescription) was conducted after the pro-forma introduction from 1st February 2013 to 24th May 2013. Frequency of assessments increased after protocol implementation with between 36% and 85% of all patients being assessed for VTE risk post intervention. Fluctuations in numbers assessed may have related to ward pressures, staff changes, and practicalities of pro-forma use. After completion of the PDSA cycles the initiative was handed over to a specialist registrar for implementation across the other trust Older Adult Psychiatry wards, and further audit was planned to be conducted via junior doctors and established Quality Assurance systems. Discussion of integration of a condensed pro-forma into the trust electronic notes system is ongoing.
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Affiliation(s)
| | - Adam Clare
- Barnet, Enfield and Haringay Mental Health Trust
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Trifiró G, Sultana J, Spina E. Are the safety profiles of antipsychotic drugs used in dementia the same? An updated review of observational studies. Drug Saf 2015; 37:501-20. [PMID: 24859163 DOI: 10.1007/s40264-014-0170-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
With an increase in the global prevalence of dementia, there is also an increase in behavioural and psychological symptoms of dementia (BPSD) for which antipsychotic drugs are often used. Despite several safety warnings on antipsychotic use in dementia, there is little evidence to support the efficacy of antipsychotics in individual BPSD symptoms or to evaluate the drug safety profile by individual antipsychotic drug. There is emerging but scarce evidence that suggests an inter-drug variability between antipsychotic safety outcomes in BPSD. The objective of this review was to examine the existing literature on antipsychotic drug use in dementia patients; in particular to see whether inter-drug differences regarding antipsychotic safety were reported. A literature search was conducted for observational studies published in the English language from 2004 to 2014 that reported the risk of all-cause mortality, cerebrovascular events, pneumonia and other outcomes such as hip/femur fracture, deep vein thrombosis (DVT) and hyperglycaemia. Six of 16 mortality studies (38%), 7 of 28 stroke studies (25%), 1 of 6 pneumonia (17%) studies and 2 of 6 fracture studies (33%) investigated inter-drug safety outcomes in elderly patients/dementia patients, while to our knowledge, there are no studies investigating the inter-drug variation of deep-vein thrombosis and hyperglycaemia risk. The results of the observational studies provide mixed results on the safety of antipsychotics in BPSD but it is clear that there are differences between the safety profiles of antipsychotic drugs. Robust evidence of such inter-drug variability could significantly improve patient safety as antipsychotics become more targeted to clinical risk factors.
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Affiliation(s)
- Gianluca Trifiró
- Department of Clinical and Experimental Medicine, Section of Pharmacology, University of Messina, Policlinco Universitario, Via Consolare Valeria, 98125, Messina, Italy,
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Wang Q, Guan L, Li RM, Zhao B. Pulmonary thromboembolism associated with olanzapine treatment. Chin Med J (Engl) 2015; 128:419-20. [PMID: 25635446 PMCID: PMC4837881 DOI: 10.4103/0366-6999.150124] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
| | | | | | - Bin Zhao
- Department of Emergency Medicine, Beijing Jishuitan Hospital, Beijing 100035, China
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Ishioka M, Yasui-Furukori N, Sugawara N, Furukori H, Kudo S, Nakamura K. Hyperprolactinemia during antipsychotics treatment increases the level of coagulation markers. Neuropsychiatr Dis Treat 2015; 11:477-84. [PMID: 25750528 PMCID: PMC4348124 DOI: 10.2147/ndt.s75176] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE The strong association between psychiatric patients who receive antipsychotics and the incidence of venous thromboembolism (VTE) is known. Although previous reports suggest that hyperprolactinemia often increases markers of activated coagulation, few studies have examined the direct relationship between the prolactin level elevated by antipsychotics and activated markers of activated coagulation. METHOD The participants included 182 patients with schizophrenia (male =89, female =93) who received antipsychotic treatments for at least 3 months. Markers of VTE (D-dimer, fibrin/fibrinogen degradation products, and thrombin-antithrombin complex) and serum prolactin concentrations were measured. RESULTS Prolactin levels were significantly correlated with the logarithmic transformation of the D-dimer (r=0.320, P=0.002) and fibrin/fibrinogen degradation product levels (r=0.236, P=0.026) but not of the thrombin-antithrombin complex level (r=0.117, ns) among men. However, no correlations were found between the VTE markers and prolactin levels among women. These results were confirmed using multiple regression analyses that included demographic factors and antipsychotic dosages. CONCLUSION The current study indicates that hyperprolactinemia is associated with an increase in markers of activated coagulation among men receiving antipsychotics. This finding clinically implies that monitoring and modulating prolactin levels among men are important to decrease the risk of VTE.
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Affiliation(s)
- Masamichi Ishioka
- Department of Neuropsychiatry, Graduate School of Medicine, Hirosaki University, Hirosaki, Japan
| | - Norio Yasui-Furukori
- Department of Neuropsychiatry, Graduate School of Medicine, Hirosaki University, Hirosaki, Japan
| | - Norio Sugawara
- Department of Neuropsychiatry, Graduate School of Medicine, Hirosaki University, Hirosaki, Japan
| | - Hanako Furukori
- Department of Neuropsychiatry, Graduate School of Medicine, Hirosaki University, Hirosaki, Japan
| | - Shuhei Kudo
- Department of Neuropsychiatry, Graduate School of Medicine, Hirosaki University, Hirosaki, Japan
| | - Kazuhiko Nakamura
- Department of Neuropsychiatry, Graduate School of Medicine, Hirosaki University, Hirosaki, Japan
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Barbui C, Conti V, Cipriani A. Antipsychotic drug exposure and risk of venous thromboembolism: a systematic review and meta-analysis of observational studies. Drug Saf 2014; 37:79-90. [PMID: 24403009 DOI: 10.1007/s40264-013-0127-6] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Venous thromboembolism (VTE) is a serious disorder that may be complicated by pulmonary embolism (PE). Case reports and observational studies published in the early 1950s suggested that antipsychotic (AP) drugs may represent a risk factor, while observational studies conducted in the last 3 decades have provided conflicting results. OBJECTIVE The aim was to investigate whether AP drugs increase the risk of VTE and PE, and to ascertain the risk associated with first- and second-generation AP drugs and with exposure to individual drugs. DATA SOURCE Relevant studies were located by searching MEDLINE, PubMed, EMBASE, PsychINFO, CINAHL and Scopus up to March 2013. Reference lists of relevant papers and previous review articles were hand searched for other relevant studies. STUDY SELECTION Based on the titles and abstracts of 1,386 citations, we identified 30 potentially relevant studies. Of these, 17 studies were eligible for inclusion and were included in the meta-analysis. MAIN OUTCOMES AND MEASURES The primary outcome measure of this meta-analysis was the occurrence of VTE or PE in individuals exposed to AP drugs in comparison with individuals unexposed or with past exposure to AP drugs. RESULTS Antipsychotic exposure was associated with a significant increase in risk of developing VTE [odds ratio (OR) 1.54, 95% confidence interval (CI) 1.28-1.86, 11 studies]. Exposure to APs did not significantly increase the risk of PE (OR 4.90, 95% CI 0.77-30.98, three studies), but the overall estimate was highly heterogeneous and the CI included the possibility of substantial harm. Random-effects meta-analysis on the risk of VTE associated with exposure to first- (OR 1.74, 95% CI 1.28-2.37, six studies) and second-generation (OR 2.07, 95% CI 1.74-2.52, five studies) APs revealed an increased risk. Only a few studies provided data on individual drugs, and estimates of effect were very uncertain. CONCLUSIONS Antipsychotic exposure in unselected patient populations may be associated with a 50% increase in the risk of developing VTE. However, between-study heterogeneity limits the confidence in this estimate. This increased risk similarly applies to first- and second-generation AP drugs.
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Affiliation(s)
- Corrado Barbui
- Section of Psychiatry, Department of Public Health and Community Medicine, University of Verona, Policlinico GB Rossi, Piazzale Scuro 10, 37134, Verona, Italy,
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Ishiguro C, Wang X, Li L, Jick S. Antipsychotic drugs and risk of idiopathic venous thromboembolism: a nested case-control study using the CPRD. Pharmacoepidemiol Drug Saf 2014; 23:1168-75. [PMID: 25195779 DOI: 10.1002/pds.3699] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Revised: 07/15/2014] [Accepted: 07/25/2014] [Indexed: 11/11/2022]
Abstract
BACKGROUND The evidence to date on the relationship between antipsychotic drugs and the risk of venous thromboembolism (VTE) is limited. PURPOSE Our aim was to examine the association between the use of typical and atypical antipsychotics and risk of VTE and to assess the effects of dose and duration of use. METHODS Among users of typical or atypical antipsychotics between 1998 and 2012 in the Clinical Practice Research Datalink, we identified all VTE cases aged 20-59 years with no major risk factors for VTE. From the same population, we randomly selected up to four controls for each case matched on age, sex, general practice, calendar time, and length of medical history. We estimated adjusted odds ratios (aORs) and 95% confidence intervals (CIs) of VTE for current and recent use of antipsychotics compared with non-use using conditional logistic regression. RESULT We identified 868 cases and 3158 matched controls. Compared with non-use, any current use of antipsychotics was associated with a marginally increased risk of VTE: aOR 1.26 (95%CI [0.97, 1.63]); for new users, the aOR was 3.21 (95%CI [1.64, 6.29]). Prochlorperazine and risperidone were associated with elevated risks of VTE (aORs 2.18, 95%CI [1.47, 3.25], and 1.83, 95%CI [0.88, 3.81], respectively). CONCLUSION The risk of VTE with typical and atypical antipsychotics varies with type of drug and is highest just after starting the drug.
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Affiliation(s)
- Chieko Ishiguro
- Boston Collaborative Drug Surveillance Program (BCDSP), Boston University School of Public Health, Lexington, MA, USA
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Sarı BA, Taşkıntuna N, Yalçın Ö. Risperidone treatment in a case of Tourette syndrome with factor V Leiden heterozygous mutation. J Child Adolesc Psychopharmacol 2014; 24:235-6. [PMID: 24815337 DOI: 10.1089/cap.2013.0125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Burcu Akın Sarı
- 1 Psychiatry Department, Başkent University Medical Faculty , Ankara, Turkey
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Şengül MCB, Kaya K, Yilmaz A, Şengül C, Serinken M. Pulmonary thromboembolism due to paliperidone: report of 2 cases. Am J Emerg Med 2013; 32:814.e1-2. [PMID: 24462396 DOI: 10.1016/j.ajem.2013.12.038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Accepted: 12/18/2013] [Indexed: 10/25/2022] Open
Abstract
Venous thromboembolism (VTE) is serious medical condition, which might be caused by psychotropic medications. Previously, antipsychotic-induced VTE due to olanzapine, risperidone, clozapine, and amisulpiride was reported. In this report, we present 2 cases of paliperidone-induced VTE.
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Affiliation(s)
| | - Kemal Kaya
- Department of Psychiatry, Isparta State Hospital, Isparta, Turkey
| | - Atakan Yilmaz
- Department of Emergency Medicine, Tekirdağ State Hospital, Tekirdağ, Turkey
| | - Cem Şengül
- Department of Psychiatry, Pamukkale University, School of Medicine, Denizli, Turkey
| | - Mustafa Serinken
- Department of Emergency Medicine, Pamukkale University, School of Medicine, Denizli, Turkey.
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Abstract
Since preliminary case reports suggesting a possible association between first generation of antipsychotics and venous thromboembolism (VTE), consistent epidemiological data is now available suggesting a moderate association between antipsychotics and VTE. However, despite several hypotheses, the underlying mechanisms remain unknown or uncertain. In addition, if the association between antipsychotics and VTE is plausible, the intensity of this risk and the dose effect relationship do not have yet been determined. Prospective data is therefore needed in order to confirm and to quantify this association. Because of the level of uncertainty, the clinical impact on the prevention and the treatment of VTE in patients with a psychiatric illness appears to be low.
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Affiliation(s)
- Cécile Tromeur
- Groupe d'Etude de la Thrombose de Bretagne Occidentale, EA 3878, Department of Internal Medicine and Chest Diseases, Brest, France
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Pulmonary embolism related to amisulpride treatment: a case report. Case Rep Psychiatry 2013; 2013:718950. [PMID: 23533901 PMCID: PMC3600277 DOI: 10.1155/2013/718950] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Accepted: 02/09/2013] [Indexed: 12/26/2022] Open
Abstract
Venous thromboembolism has been associated with antipsychotic drugs, but the underlying mechanisms are largely unknown. Hypotheses that have been made include body weight gain, sedation, enhanced platelet aggregation, increased levels of antiphospholipid antibodies, hyperhomocysteinemia, whereas hyperprolactinemia has recently attracted attention as a potential contributing factor. The highest risk has been demonstrated for clozapine, olanzapine, and low-potency first-generation antipsychotics; however, presently there is no data for amisulpride. In the present paper we describe a case of pulmonary embolism in a female bipolar patient, receiving treatment with amisulpride, aripiprazole, and paroxetine. Although a contribution of aripiprazole and paroxetine cannot completely be ruled out, the most probable factor underlying the thromboembolic event seems to be hyperprolactinemia, which was caused by amisulpride treatment. Increased plasma levels of prolactin should probably be taken into account during the monitoring of antipsychotic treatment as well as in future research concerning venous thromboembolism in psychiatric settings.
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Min SY, Shin JH, Lee SW, Doo E, Kim BK, Won YW, Park HC, Choi SI, Kim SG. A case of deep vein thrombosis after coronary angiography in a patient using antidepressants and anxiolytics. Korean Circ J 2013; 43:132-4. [PMID: 23508451 PMCID: PMC3596662 DOI: 10.4070/kcj.2013.43.2.132] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2012] [Revised: 06/18/2012] [Accepted: 07/06/2012] [Indexed: 12/03/2022] Open
Abstract
Deep vein thrombosis (DVT) is a rare but potentially serious complication of coronary angiography (CAG) affecting just under 5 in 10000 patients. Most of the cases regarding DVT after CAG reported in the literature were associated with procedure-related vascular complications or with risk factors for venous thromboembolism (VTE). Here, we describe the case of a 50-year-old woman during treatment for anxiety disorder, who developed significant DVT after CAG without a history of VTE and with no significant risk factors for VTE, which was treated with an anticoagulant. This case reminds us that clinicians should consider the possible occurrence of VTE after diagnostic CAG even in patients without significant risk factors.
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Affiliation(s)
- Seung Yeon Min
- Devision of Cardiology, Department of Internal Medicine, Hanyang University College of Medicine, Guri, Korea
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Abstract
OBJECTIVE To investigate the association between venous thromboembolism (VTE) and antidepressant use in an Asian population. METHODS The authors conducted a nested case-control study of 1888 patients with VTE and 11,222 matched controls enrolled in the National Health Insurance Research Database in Taiwan from 2001 to 2009. The antidepressant exposure status and potential confounding factors were measured and included in the analyses. Conditional logistic regressions were applied to determine the effect of antidepressant use on VTE. RESULTS We found a significant association of current antidepressant use with VTE in the total study sample (adjusted odds ratio [aOR], 1.59; 95% confidence interval (CI), 1.27-2.00). With regard to antidepressant classes and potency, we found that tricyclic antidepressants (aOR, 1.56; 95% CI, 1.11-2.18), serotonin 5-HT2A receptor blockers (aOR, 2.03; 95% CI, 1.27-3.24), and antidepressants with a low potency of serotonin reuptake inhibition (aOR, 1.57; 95% CI, 1.18-2.08) were associated with a significantly increased risk of VTE. When further stratifying by age, sex, and comorbid conditions, the VTE risk with antidepressant use was elevated among young and middle-aged adults, but not among the elderly. In addition, an elevated risk of VTE was observed in women and subjects without severe comorbid conditions, but not in men and subjects with severe comorbid conditions. CONCLUSIONS There was a small increase in VTE risk with antidepressant use. The prescription of antidepressant drugs should be cautious, and especially, should be based on clinical evaluations of benefits and risks. The underlying mechanisms of the interaction between antidepressants and VTE warrant further investigation.
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Patients receiving antipsychotic agents have an increased risk of venous thromboembolism. DRUGS & THERAPY PERSPECTIVES 2013. [DOI: 10.1007/s40267-012-0002-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Masopust J, Malý R, Vališ M. Risk of venous thromboembolism during treatment with antipsychotic agents. Psychiatry Clin Neurosci 2012; 66:541-52. [PMID: 23252920 DOI: 10.1111/pcn.12001] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2012] [Revised: 05/18/2012] [Accepted: 06/15/2012] [Indexed: 02/06/2023]
Abstract
The evidence to date on the relation between the risk of venous thromboembolic disease (VTE) and antipsychotic agents derives primarily from observational and case history studies. While an increased risk of VTE has been associated with first-generation low-potency antipsychotic agents, particularly clozapine, there appears to be a growing number of reports on the occurrence of this adverse reaction during the use of second-generation antipsychotics, such as risperidone and olanzapine. The highest risk of pathological blood clotting emerges during the first 3 months after initiation of treatment with the product. Potential etiopathogenetic factors leading to VTE during treatment with antipsychotic agents include sedation, obesity, elevation of antiphospholipid antibodies, increased platelet activation and aggregation, hyperhomocysteinemia, and hyperprolactinemia. Diagnoses of schizophrenia and/or bipolar affective disorder, as well as hospitalization or stress with sympathetic activation and elevation of catecholamine levels, have been reported as known prothrombogenic factors. The present article contains the new version of the guideline for the prevention of VTE in psychiatric patients with limited mobility. Further prospective studies are necessary to elucidate the biological mechanisms of the relations between antipsychotic agents and VTE.
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Affiliation(s)
- Jiří Masopust
- Department of Psychiatry, Charles University and University Hospital, Hradec Králové, Czech Republic.
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Gallerani M, Imberti D, Mari E, Marra A, Manfredini R. Risperidone and pulmonary embolism: a harmful association? Case series and review of the literature. Acta Neuropsychiatr 2012; 24:361-8. [PMID: 25287179 DOI: 10.1111/j.1601-5215.2012.00641.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Gallerani M, Imberti D, Mari E, Marra A, Manfredini R. Risperidone and pulmonary embolism: a harmful association? Case series and review of the literature.Objective: Risperidone is an atypical antipsychotic drug used to treat a number of psychiatric diseases, such as schizophrenia, schizoaffective and bipolar disorders and irritability in children with autism. Moreover, it is also often administered for short-term treatment of persistent aggression in people with moderate-to-severe Alzheimer's dementia. A possible association between risperidone and venous thromboembolism (VTE) has been described. We intended to verify the dimension of the problem in our hospital setting.Methods: We considered all consecutive patients hospitalised in our Internal Medicine Department from January 2004 to December 2010, who were treated with risperidone and presented pulmonary embolism (PE).Results: Four cases of patients, apparently free from the well-known major risk factors for VTE (i.e. cancer, prolonged immobilisation, acute cardiac and respiratory failure, infections), who presented PE associated with risperidone therapy, were reported in details.Conclusions: A review of the available literature, discussing the possible different pathogenic reasons for this increased risk of VTE, is provided.
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Affiliation(s)
- Massimo Gallerani
- Internal Medicine, Az. Ospedaliera Universitaria "St. Anna", Ferrara, Italy
| | - Davide Imberti
- Internal Medicine, Az. Ospedaliera Universitaria "St. Anna", Ferrara, Italy
| | - Elisa Mari
- Internal Medicine, Az. Ospedaliera Universitaria "St. Anna", Ferrara, Italy
| | - Anna Marra
- Pharmaceutical Department, Az. Ospedaliera Universitaria "St. Anna", Ferrara, Italy
| | - Roberto Manfredini
- Department of Clinical and Experimental Medicine, Clinica Medica and Vascular Diseases Center, University of Ferrara, Ferrara, Italy
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Incidence of venous thromboembolism in psychiatric units. Thromb Res 2012; 130:e283-8. [PMID: 23092750 DOI: 10.1016/j.thromres.2012.10.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2012] [Revised: 09/07/2012] [Accepted: 10/09/2012] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Incidence and risk factors of venous thromboembolism (VTE) are well established in surgical and medical settings, but data in psychiatric units are lacking. The aim of this study was to estimate the incidence of VTE in hospitalized psychiatric patients, and to assess the risk factors for VTE in this specific population. MATERIALS AND METHODS All consecutive adult patients, admitted for a psychiatric disorder for at least seven days in psychiatric units were considered for inclusion. Patients were evaluated for signs and symptoms of VTE during hospitalization. At Day 10, all participants were interviewed and a systematic compression ultrasonography of the lower limbs was performed. Patients were followed-up until Day 90. RESULTS Among the 471 included patients, 449 were evaluable at Day 10, and 458 were followed-up until Day 90. Ten deep vein thromboses (DVT) were diagnosed by Day 10 leading to an incidence of VTE of 2.2% (95% CI, 1.1%-4.1%). Six additional symptomatic VTE occurred between Day 10 and Day 90, leading to a 3.5% incidence at Day 90 (95% CI, 2.0%-5.6%). The main factors associated with VTE were age, bed rest, and diagnosis of dementia. The incidence of VTE in patients aged 75 or over with a diagnosis of dementia reached 8.2% at Day 10 and 12.5% at Day 90. CONCLUSIONS The incidence of VTE in psychiatric units appeared low. However, in older patients, especially those with dementia, the incidence of VTE increased considerably. Further studies are needed to confirm these results.
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Jönsson AK, Spigset O, Hägg S. Venous thromboembolism in recipients of antipsychotics: incidence, mechanisms and management. CNS Drugs 2012; 26:649-62. [PMID: 22731933 DOI: 10.2165/11633920-000000000-00000] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Since chlorpromazine was introduced to the market in the early 1950s, the use of antipsychotic drugs has been associated with venous thromboembolism (VTE) in a number of reports. During the last decade the evidence has been strengthened with large epidemiological studies. Whether all antipsychotics increase the risk for VTE or the risk is confined to certain drugs is still unclear. The aim of this article is to present an updated critical review focusing on the incidence, mechanisms and management of VTE in users of antipsychotics. After searching the databases PubMed and Scopus for relevant articles we identified 12 observational studies, all of which were published after the year 2000. In most of these studies an elevated risk of VTE was observed for antipsychotic drugs, with the highest risk for clozapine, olanzapine and low-potency first-generation antipsychotics. The risk seems to be correlated with dose. The elderly, who mainly use lower doses, do not show an increased risk of VTE to the same extent as younger subjects. The underlying biological mechanisms explaining the association between antipsychotic medication and VTE are to a large extent unknown. Several hypotheses have been proposed, such as body weight gain, sedation, enhanced platelet aggregation, increased levels of antiphospholipid antibodies, hyperprolactinaemia and hyperhomocysteinaemia. The risk of VTE in schizophrenia and other psychotic disorders may also be related to the underlying disease rather than the medication. Very limited evidence exists to guide how cases of VTE in subjects using antipsychotics should be handled. An attempt to compile an algorithm where the patients' individual risk of VTE is assessed and preventive clinical measures are suggested has been published recently. Strong consideration should be given to discontinuation of the offending antipsychotic drug in patients experiencing a VTE, and another antipsychotic drug with a presumably lower risk should be chosen if antipsychotic drug treatment is still indicated. It is essential that physicians and patients are aware that VTE may be an adverse drug reaction to the antipsychotic treatment so the condition is identified early and treated appropriately.
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Affiliation(s)
- Anna K Jönsson
- Department of Drug ResearchClinical Pharmacology, Faculty of Health Sciences, Linkping University, Department of Clinical Pharmacology, County Council of Linkping, Linkping, Sweden
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Allenet B, Schmidlin S, Genty C, Bosson JL. Antipsychotic drugs and risk of pulmonary embolism. Pharmacoepidemiol Drug Saf 2011; 21:42-8. [DOI: 10.1002/pds.2210] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2011] [Revised: 05/20/2011] [Accepted: 06/22/2011] [Indexed: 12/23/2022]
Affiliation(s)
| | - Sophie Schmidlin
- Clinical Research Center; Grenoble University Hospital; Grenoble; France
| | - Céline Genty
- ThEMAS TIMC; Joseph Fourier University; Grenoble; France
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Mehta S, Chen H, Johnson M, Aparasu RR. Risk of serious cardiac events in older adults using antipsychotic agents. ACTA ACUST UNITED AC 2011; 9:120-32. [PMID: 21565711 DOI: 10.1016/j.amjopharm.2011.03.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2011] [Indexed: 11/26/2022]
Abstract
BACKGROUND Antipsychotic agents can lead to severe cardiovascular adverse events due to multiple mechanisms involving electrophysiologic and metabolic effects. Few epidemiologic studies have evaluated the risk of serious cardiovascular-related events in typical and atypical antipsychotic users. OBJECTIVE The purpose of this study was to compare the risk of serious cardiac events in older adults taking typical antipsychotics with those taking atypical antipsychotics. METHODS Prescription and medical information were derived from the IMS LifeLink Health Plan Claims database. The study involved a retrospective cohort of older adults (≥50 years) taking atypical or typical antipsychotics from July 1, 2000, to December 31, 2007. The primary outcome measure was hospitalization or emergency room visit due to serious cardiac events, including thromboembolism, myocardial infarction, cardiac arrest, and ventricular arrhythmias within 1 year after the index date. The 2 groups were matched on a propensity score to minimize the baseline differences between the groups. Survival analysis was conducted on the matched cohort to assess the risk of serious cardiovascular events in typical versus atypical users. RESULTS A total of 5580 patients were selected in each antipsychotic users group after propensity score matching. Serious cardiac events were found in 666 (11.9 %) atypical antipsychotic users and 698 (12.4%) typical antipsychotic users. Survival analysis revealed that typical antipsychotic users were at increased risk of serious cardiovascular events compared with atypical antipsychotic users (hazard ratio = 1.21; 95% CI, 1.04-1.40) after controlling for other factors. CONCLUSIONS Moderate increases in risk of serious cardiac events are associated with older adults using typical antipsychotic agents compared with atypical users. Health care professionals should carefully evaluate the benefit/risk ratio of antipsychotic agents before prescribing these agents to a vulnerable population.
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Affiliation(s)
- Sandhya Mehta
- Department of Clinical Sciences and Administration, College of Pharmacy, University of Houston, Texas Medical Center, Houston, USA
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Zhou H, Tang Y, Yan Y, Yi Q, Du X, Liang Z. Antidepressant Drugs and Risk of Venous Thromboembolism: A Case Report and Literature Review. KLINIK PSIKOFARMAKOLOJI BÜLTENI-BULLETIN OF CLINICAL PSYCHOPHARMACOLOGY 2011. [DOI: 10.5455/bcp.20110815070819] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Haixia Zhou
- Respiratory Department of West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China
| | - Yongjiang Tang
- Respiratory Department of West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China
| | - Yu Yan
- Respiratory Department of West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China
| | - Qun Yi
- Respiratory Department of West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China
| | - Xinmiao Du
- Respiratory Department of West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China
| | - Zongan Liang
- Respiratory Department of West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China
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Perioperative pulmonary embolism: diagnosis and anesthetic management. J Clin Anesth 2011; 23:153-65. [DOI: 10.1016/j.jclinane.2010.06.011] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2009] [Revised: 06/18/2010] [Accepted: 06/29/2010] [Indexed: 12/17/2022]
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Masopust J, Malý R, Andrýs C, Vališ M, Bažant J, Hosák L. Markers of thrombogenesis are activated in unmedicated patients with acute psychosis: a matched case control study. BMC Psychiatry 2011; 11:2. [PMID: 21199572 PMCID: PMC3022806 DOI: 10.1186/1471-244x-11-2] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2010] [Accepted: 01/03/2011] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Antipsychotic treatment has been repeatedly found to be associated with an increased risk for venous thromboembolism in schizophrenia. The extent to which the propensity for venous thromboembolism is linked to antipsychotic medication alone or psychosis itself is unclear. The objective of this study was to determine whether markers of thrombogenesis are increased in psychotic patients who have not yet been treated with antipsychotic medication. METHODS We investigated the plasma levels of markers indicating activation of coagulation (D-dimers and Factor VIII) and platelets (soluble P-selectin, sP-selectin) in an antipsychotic-naive group of fourteen men and eleven women with acute psychosis (age 29.1 ± 8.3 years, body mass index 23.6 ± 4.7), and twenty-five healthy volunteers were matched for age, gender and body mass index. RESULTS D-dimers (median 0.38 versus 0.19 mg/l, mean 1.12 ± 2.38 versus 0.28 ± 0.3 mg/l; P = 0.003) and sP-selectin (median 204.1 versus 112.4 ng/ml, mean 209.9 ± 124 versus 124.1 ± 32; P = 0.0005) plasma levels were significantly increased in the group of patients with acute psychosis as compared with healthy volunteers. We found a trend (median 148% versus 110%, mean 160 ± 72.5 versus 123 ± 62.5; P = 0.062) of increased plasma levels of factor VIII in psychotic patients as compared with healthy volunteers. CONCLUSIONS The results suggest that at least a part of venous thromboembolic events in patients with acute psychosis may be induced by pathogenic mechanisms related to psychosis rather than by antipsychotic treatment. Finding an exact cause for venous thromboembolism in psychotic patients is necessary for its effective treatment and prevention.
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Affiliation(s)
- Jiří Masopust
- Dept, of Psychiatry, Charles University in Prague, Faculty of Medicine in Hradec Králové, and University Hospital Hradec Králové, Czech Republic.
| | - Radovan Malý
- 1st Dept. of Internal Medicine, Charles University in Prague, Faculty of Medicine in Hradec Králové, and University Hospital Hradec Králové, Czech Republic
| | - Ctirad Andrýs
- Institute of Clinical Immunology and Allergology, Charles University in Prague, Faculty of Medicine in Hradec Králové, and University Hospital Hradec Králové, Czech Republic
| | - Martin Vališ
- Dept. of Neurology, Charles University in Prague, Faculty of Medicine in Hradec Králové, and University Hospital Hradec Králové, Czech Republic
| | - Jan Bažant
- Dept. of Psychiatry, Charles University in Prague, Faculty of Medicine in Hradec Králové, and University Hospital Hradec Králové, Czech Republic
| | - Ladislav Hosák
- Dept. of Psychiatry, Charles University in Prague, Faculty of Medicine in Hradec Králové, and University Hospital Hradec Králové, Czech Republic
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Abstract
OBJECTIVE Our aim was to investigate the relationship between exposure to antipsychotic drugs and the risk of venous thromboembolism (VTE) in elderly patients. METHODS A time-matched case-control analysis nested within a cohort of 111,818 patients with at least 1 antipsychotic drug prescription during 1998 to 2008. Data were used from the PHARMO institute's database, which contains drug dispensing data from community pharmacies and hospital admission data. The index date was for the cases defined as the date of hospital admission for VTE (deep venous thrombosis [DVT] or pulmonary embolism) or, for outpatient cases, the start of therapeutic dose low-molecular weight heparin therapy. For each case, 4 controls matched by age and sex were randomly sampled from the cohort. MEASUREMENTS Two measures were used to evaluate the temporal relationship between antipsychotic drug use and the occurrence of VTE: being a current, recent, or past user and the duration of use up to the index date. The strength of the association was expressed as odds ratios with 95% confidence intervals, taking into account potential confounders. RESULTS We identified 367 cases of hospital admission for DVT, 342 cases of hospital admission for PE, and 323 cases of outpatient treatment of DVT. Current exposure to antipsychotic drugs was not associated with an increased risk of VTE, compared with nonusers (odds ratio, 0.9; 95% confidence interval, 0.7-1.1). We found no association between dosage, the duration of use, or the type of antipsychotic drug and the risk of VTE. CONCLUSIONS We found no evidence of an increased risk of VTE in elderly patients using antipsychotic drugs.
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Muzyk AJ, Jakel RJ, Preud’homme X. Serotonin Syndrome After a Massive Overdose of Controlled-Release Paroxetine. PSYCHOSOMATICS 2010. [DOI: 10.1016/s0033-3182(10)70727-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Hägg S, Jönsson AK, Spigset O. Risk of venous thromboembolism due to antipsychotic drug therapy. Expert Opin Drug Saf 2009; 8:537-47. [PMID: 19569978 DOI: 10.1517/14740330903117271] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
An increasing number of reports suggest a link between venous thromboembolism (VTE) and the use of antipsychotics. To better understand this association the available body of evidence has been critically scrutinised. Relevant articles were identified in the databases Scopus and PubMed. Several observational studies using different methodologies show an increased risk of VTE in psychiatric patients. This elevated risk seems to be related to the use of antipsychotic medication and in particular to the use of clozapine and low-potency first-generation drugs. Many studies investigating the association have, however, methodological limitations. The biological mechanisms involved in the pathogenesis of this possible adverse reaction are largely unknown but several hypotheses have been suggested such as drug-induced sedation, obesity, increased levels of antiphospholipid antibodies, enhanced platelet aggregation, hyperhomocysteinemia and hyperprolactinemia. The association may also be related to underlying risk factors present in psychotic patients. Physicians need to be aware of this possible adverse drug reaction. Although supporting evidence has not been published they should consider discontinuing or switching the antipsychotic treatment in patients experiencing VTE. In addition, although data is lacking, the threshold for considering prophylactic antithrombotic treatment should be low when risk situations for VTE arise, such as immobilisation, surgery and so on.
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Affiliation(s)
- Staffan Hägg
- Linköping University, Department of Drug Research, Section of Clinical Pharmacology, S-581 83 Linköping, Sweden.
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Abstract
CONTEXT The health burden of antipsychotic medication is well known, but the disproportionate effect on women as compared with men is underappreciated. OBJECTIVE The goal of this article is preventive--to better inform clinicians so that the risks to women and to their offspring can be diminished. METHOD All PubMed sources in which the search term gender (or sex) was linked to a side effect of antipsychotic medication were reviewed. RESULT There is general agreement in the literature on women's increased susceptibility to weight gain, diabetes, and specific cardiovascular risks of antipsychotics, with less consensus on malignancy risks and risks to the fetus. Cardiovascular death, to which men are more susceptible than women, is disproportionately increased in women by the use of antipsychotics. Sedating antipsychotics raise the risk of embolic phenomena during pregnancy, and postpartum. Prolactin-elevating drugs suppress gonadal hormone secretion and may enhance autoimmune proclivity. CONCLUSIONS Clinicians need to be aware of the differential harm that women (and their offspring) can incur from the side effects of antipsychotics.
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