Association of Antipsychotic Drugs with Venous Thromboembolism: Data Mining of Food and Drug Administration Adverse Event Reporting System and Mendelian Randomization Analysis

Association of diuretics with falls and wrist fractures: a Mendelian randomization study

Background

The association between diuretics and falls in older adult has been reported in previous studies, but discrepancy remains between the different types of diuretics. The association of diuretics with the risk of wrist fractures due to diuretics is also unclear. Therefore, in this study, we determined the association of diuretics with falls and wrist fractures by Mendelian randomization.

Methods

We used a two-sample Mendelian randomization (MR) approach to evaluate the effects of the loop diuretics\potassium-sparing diuretics\thiazide diuretics (LDs\PSDs\TDs) on the risk of falls and wrist fracture using the three diuretic-associated genetically-predicted single nucleotide polymorphisms (SNPs) as genetic tools. The inverse variance weighting (IVW) method was used as the main evaluation method, with odds ratio (OR) as the evaluation criterion. Additionally, weighted median (WME), MR-Egger, weighted mode (WM) and simple mode (SM) methods were used together for the MR analysis, and sensitivity analyses were performed to assess the robustness of the main results.

Result

A total of 35 SNPs were included in this study as instrumental variables to replace LDs, PSDs, and TDs, which were 24, 7, and 4. Genetic substitutions for diuretics associated with increased risk of falls were LDs (OR = 1.012043, 95%CI: 1.001607-1.022588, p = 0.022337), PSDs (OR = 1.023794, 95%CI: 1.005605-1.042312, p = 0.010138). Genetically proxied TDs showed no association with falls, but the use of TDs showed a negative correlation with the incidence of wrist fracture (OR = 0.833, 95%CI: 0.767-0.905, p < 0.001). The Cochran Q-test showed no heterogeneity and MR-PRESSO method excluded data pleiotropy.

Conclusion

Our findings suggest that the use of loop diuretics (LDs) or potassium-sparing diuretics (PSDs) increases the incidence of falls, but there is no causal relationship between thiazide diuretics (TDs) and falls, and TDs may actually reduce the risk of wrist fractures. Clinical use of diuretics necessitates vigilance and appropriate preventive measures to minimize fall-related events.

The Risk of Venous Thromboembolism Events Resulting in Hospitalization following Exposure to Antipsychotic Medication in Pre-Disposed Adult Patients

Introduction: The primary objective of this study was to compare the incidence of antipsychotic use in those with venous thromboembolism (VTE) resulting in hospital admission. This study expands upon current knowledge regarding VTE risk and antipsychotic use and investigates potential risk factors and lab values that may precede antipsychotic-induced coagulopathy. Methods: This retrospective, case-control, chart review investigated patients admitted to an acute care hospital with either a VTE or non-VTE diagnosis. Primary outcome analysis compared the presence of an antipsychotic medication in patients who had a VTE versus those who did not. Secondary analysis included: 1) the duration, class, dose, frequency, and route of antipsychotic and 2) coagulation parameters, patient characteristics, and VTE risk factors. Results: Analysis included 400 participants with 200 participants in each group (VTE and non-VTE). Of the 51 patients who received an antipsychotic, 29 (56.9%) developed or presented with a VTE. However, there was no significant difference in VTE development between groups when controlled for antipsychotic use (OR 1.37, 95% CI 0.76-2.50, P-value=0.30). Conclusion: While primary study findings were not statistically significant, results support a weak association of exposure to antipsychotic(s) in VTE groups compared to control (non-VTE). Obesity significantly increased the odds of VTE whereas a history of type 2 diabetes significantly decreased the odds of VTE.