Antipsychotic medications and stroke in schizophrenia: A case-crossover study

Chen, Wen Yin; Chen, Lian‐Yu; Liu, Hsing Cheng; Wu, Chi‐Shin; Yang, Shu Yu; Pan, Chun‐Hung; Tsai, Shang Ying; Chen, Chiao Chicy; Kuo, Chian Jue

doi:10.1371/journal.pone.0179424

Cited by 21 publications

(19 citation statements)

References 29 publications

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“…The pharmacokinetic interaction of carbamazepine and first-generation antipsychotics consequently contradicts the synergic effects of these two drugs for the elevated risk of stroke observed in this study. Given that the distinct receptor profiles of antipsychotic medications can contribute to the different level of stroke risk, 13,22 further research with detailed differentiation of prescribed antipsychotic medications is needed to validate our observations.…”

Section: Combination Therapy and The Risk Of Strokementioning

confidence: 84%

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Mood stabilisers and risk of stroke in bipolar disorder

et al. 2018

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BackgroundResearch on the risk of stroke following the use of mood stabilisers specific to patients with bipolar disorder is limited.AimsIn this study, we investigated the risk of stroke following the exposure to mood stabilisers in patients with bipolar disorder.MethodData for this nationwide population-based study were derived from the Taiwan National Health Insurance Research Database. Among a retrospective cohort of patients with bipolar disorder (n = 19 433), 609 new-onset cases of stroke were identified from 1999 to 2012. A case–crossover study design utilising 14-day windows was applied to assess the acute exposure effect of individual mood stabilisers on the risk of ischaemic, haemorrhagic and other types of stroke in patients with bipolar disorder.ResultsMood stabilisers as a group were significantly associated with the increased risk of stroke in patients with bipolar disorder (adjusted risk ratio, 1.26; P = 0.041). Among individual mood stabilisers, acute exposure to carbamazepine had the highest risk of stroke (adjusted risk ratio, 1.68; P = 0.018), particularly the ischaemic type (adjusted risk ratio, 1.81; P = 0.037). In addition, acute exposure to valproic acid elevated the risk of haemorrhagic stroke (adjusted risk ratio, 1.76; P = 0.022). In contrast, acute exposure to lithium and lamotrigine did not significantly increase the risk of any type of stroke.ConclusionsUse of carbamazepine and valproic acid, but not lithium and lamotrigine, is associated with increased risk of stroke in patients with bipolar disorder.Declaration of interestNone.

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Section: Combination Therapy and The Risk Of Strokementioning

confidence: 84%

“…Concomitant drugs included cardiovascular drugs, drugs used in diabetes, antithrombotic agents, respiratory drugs, corticosteroids, antipsychotics, antidepressants and benzodiazepines. These factors were selected because of their potential association with the risk of stroke 13 …”

Section: Methodsmentioning

confidence: 99%

Mood stabilisers and risk of stroke in bipolar disorder

et al. 2018

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“…Poorer secondary prevention has been shown previously in ischemic heart disease (16), and a study from the US reported that the Framingham 10-year risk of coronary heart disease was increased by 79% in patients with schizophrenia (9). One potential driver of poorer cardiovascular health in these patients could be the cardiovascular side effects of antipsychotic drugs (13, 22).…”

Section: Discussionmentioning

confidence: 99%

The Association of Pre-stroke Psychosis and Post-stroke Levels of Health, Resource Utilization, and Care Process: A Register-Based Study

et al. 2018

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Background: While approximately one percent of the global population is formally diagnosed with psychosis or schizophrenia, the actual number is expected to be significantly higher. These patients often consume more healthcare resources and have poorer somatic health. In this study, we analyze potential differences in health, resources, and care process between stroke patients with and without a previous diagnosis of psychosis or schizophrenia.Methods: Ischemic stroke patients from seven regions in Sweden were identified via ICD-10 codes (I63.0-9) in regional administrative systems and the Swedish Stroke Register, and approximately 70% of all ischemic stroke cases in Sweden during 2008–2011 were included (n = 46,350). Relevant patient-level data from national registries were linked to enable multivariate regression analysis, including data on socioeconomics, mortality, municipality services, and filled prescriptions. History of psychosis or schizophrenia was defined via ICD-10 codes F20-29 (n = 389).Results: Patient-reported functional outcomes at 3 months and 1 year were significantly lower in the psychosis subgroup, and stroke recurrence was higher. Patients with pre-stroke psychosis did not receive the same levels of reperfusion treatment as the non-psychosis group. Time at the stroke unit was the same, as were first-year levels of somatic care, but dispensation of antihypertensives was less common.Conclusion: Our findings emphasize the importance of taking mental comorbidity into account during stroke treatment as well as when evaluating indicators for health, resources, and the care process, since mental comorbidity such as psychosis or schizophrenia may have a significant impact the year preceding and the year succeeding the stroke event.

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“…Use of antidiabetic drugs, antihypertensives, lipid lowering agents, antiplatelets, oral anticoagulants, non-steroidal anti-inflammatory drugs, and antipsychotics were grouped according to the anatomical therapeutic chemical classification system ( S3 Table ). Non-steroidal anti-inflammatory drugs and antipsychotics were evaluated because they have been found to increase the risk of ischemic stroke [ 15 – 18 ].…”

Section: Methodsmentioning

confidence: 99%

Risk of ischemic stroke after discharge from inpatient surgery: Does the type of surgery matter?

Hsieh

Huang

et al. 2018

PLoS ONE

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ObjectiveStroke is a well-known and devastating complication during the perioperative period. However, detailed stroke risk profiles within 90 days in patients discharged without stroke after inpatient surgery are not fully understood. Using the case-crossover design, we aimed to evaluate the risk of ischemic stroke in these patients.MethodsWe included adult patients with the first hospitalization for ischemic stroke between 2011 and 2012 from 23 million enrollees in the National Health Insurance Research Database. Admission date of the hospitalization was defined as the case day and exactly 365 days before the admission date as the control day. The exposure was the last hospitalization for surgery within 1–30, 31–60, or 61–90 days (case period) before the case day or similar time intervals (control period) before the control day. Surgical types were grouped based on the International Classification of Diseases procedure codes. We performed conditional logistic regression adjusting for time-varying variables to determine the relationship between surgery and subsequent stroke, and case-time-control analyses to examine whether the results were confounded by the time-trend in surgery.ResultsA total of 56596 adult patients (41% female, mean age 69 years) comprised the study population. After adjustment was made for confounding variables, an association between stroke and prior inpatient surgery within 30 days was observed (adjusted odds ratio 1.44; 95% confidence interval 1.29–1.61). Cardiothoracic, vascular, digestive surgery, and musculoskeletal surgery within 30 days independently predicted ischemic stroke in the case-crossover analysis. In the case-time-control analysis, inpatient surgery remained an independent risk factor for ischemic stroke, whereas only cardiothoracic, vascular, and digestive surgery independently predicted ischemic stroke.ConclusionsSurgery as a whole independently increased the risk of ischemic stroke within 30 days. Among various types of surgery, cardiothoracic, vascular, and digestive surgery significantly increased the risk of ischemic stroke.

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Antipsychotic medications and stroke in schizophrenia: A case-crossover study

Cited by 21 publications

References 29 publications

Mood stabilisers and risk of stroke in bipolar disorder

Mood stabilisers and risk of stroke in bipolar disorder

The Association of Pre-stroke Psychosis and Post-stroke Levels of Health, Resource Utilization, and Care Process: A Register-Based Study

Risk of ischemic stroke after discharge from inpatient surgery: Does the type of surgery matter?

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