Neuroleptics from the Law Project for Psychiatric Rights

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Neuroleptics and Fatal Blood Clots

Antipsychotic drugs and risk of venous thromboembolism: nested case-control study, byChris Parker, Carol Coupland, and Julia Hippisley-Cox, British Medical Journal, 341:c4245 (2010)
Fatal venous thromboembolism associated with antipsychotic therapy, Farah RE, Makhoul NM, Farah RE, Shai MD., Ann Pharmacother. 2004 Sep;38(9):1435-8.
Psychotropic drugs and fatal pulmonary embolism, by Parkin L, Skegg DC, Herbison GP, Paul C., by Pharmacoepidemiol Drug Saf. 2003 Dec;12(8):647-52. Compared to non-use, the adjusted odds ratio for current use of antipsychotic drugs was 13.3 (95% CI: 2.3-76.3). Low potency antipsychotics appeared to carry the highest risk (odds ratio: 20.8 [95% CI: 1.7-259.0]). The main drug involved was thioridazine. The odds ratio for current use of antidepressants was also increased, at 4.9 (95% CI: 1.1-22.5).
Antipsychotic medication and venous thrombosis, by Thomassen R, Vandenbroucke JP, Rosendaal FR, Br J Psychiatry. 2001 Jul;179:63-6. Venous thrombosis appears to be associated with the use of antipsychotic drugs in psychiatric patients.
Antipsychotic drug use and risk of first-time idiopathic venous thromboembolism: a case-control study, by Zornberg GL, Jick H, Lancet. 2000 Oct 7;356(9237). This article concluded current exposure to conventional antipsychotic drugs significantly increases the risk of idiopathic venous thromboembolism in men and women younger than 60 years of age. A letter and the author's response are also included.
Venous thromboembolism among elderly patients treated with atypical and conventional antipsychotic agents, by Liperoti R, Pedone C, Lapane KL, Mor V, Bernabei R, Gambassi G., Archives of Internal Medicine, 2005 Dec 12-26;165(22):2677-82. This study concluded atypical antipsychotic agents appear to increase the risk of Venous thromboembolism among elderly patients.
Associations Between Venous Thromboembolism and Antipsychotics : A Study of the WHO Database of Adverse Drug Reactions, by Hägg S, Bate A, Stahl M, Spigset O.Drug Saf. 2008;31(8):685-94. This study concluded venous thromboembolism was more often reported with the antipsychotic drugs olanzapine, sertindole and zuclopenthixol than with other drugs in the WHO database.
Hyperprolactinemia in patients on antipsychotic drugs causes ADP-stimulated platelet activation that might explain the increased risk for venous thromboembolism: pilot study, by Wallaschofski H, Eigenthaler M, Kiefer M, Donné M, Hentschel B, Gertz HJ, Lohmann T., J Clin Psychopharmacol. 2003 Oct;23(5):479-83. Hyperprolactinemia might be the yet unknown acquired risk factor in patients on antipsychotic drugs explaining the increased risk for venous thromboembolism in these patients.

Neuroleptics: increased rate of venous thromboembolic events, Prescrire Int. 2006 Dec;15(86):224. (1) Neuroleptics have long been implicated in venous thromboembolic effects. (2) A cohort study of elderly patients showed that users of atypical neuroleptics have twice the relative risk of hospital admission for thromboembolism (95% confidence interval 1.50-2.70). (3) Results of a case-control study of 42 patients with a history of venous thromboembolism were similar: the risk of thrombosis increased by a factor of at least 7 among users of conventional neuroleptics under 60 years of age. (4) A case-control study of 62 cases of fatal pulmonary embolism showed a 13-fold higher risk among neuroleptic users. (5) It is not possible to compare the risks associated with conventional and atypical neuroleptics. (6) In practice, the risk of venous thromboembolism should be taken into account when deciding whether or not to prescribe a neuroleptic, and it should also be borne in mind during treatment.

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