Assessing the Rate of Antipsychotic Use in Ambulatory Care Patients With a Venous Thromboembolism

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.

Current antipsychotic agent use and risk of venous thromboembolism and pulmonary embolism: a systematic review and meta-analysis of observational studies

“…Of these, 45 studies were excluded because of the reasons reported in the diagram ( Figure 1 ). Therefore, 28 studies 13 – 16 , 19 , 21 – 28 , 33 – 47 were eligible for inclusion and quality assessment.…”

“…Table 1 shows the characteristics of the 28 studies included in the meta-analysis. Of all the included studies, 17 were case-control studies, 14 , 16 , 19 , 21 , 22 , 24 , 33 – 35 , 37 – 42 , 45 , 46 of which nine had a nested case-control design. 14 , 16 , 19 , 21 , 40 – 42 , 45 , 46 Eleven were cohort studies.…”

“… 14 , 16 , 19 , 21 , 40 – 42 , 45 , 46 Eleven were cohort studies. 13 , 15 , 23 , 25 – 28 , 36 , 43 , 44 , 47 In terms of data sources, 20 studies identified patients from databases, 13 – 16 , 19 , 21 , 23 , 25 , 26 , 28 , 36 , 37 , 40 – 47 four studies identified patients from hospital medical records, 22 , 24 , 27 , 38 two used autopsy records, 35 , 39 one study used both police records and hospital records, 34 and one used previous cohort study data. The patient populations of most of these studies were heterogeneous, and diagnostic categories were not restricted.…”

“…Of these, 45 studies were excluded because of the reasons reported in the diagram (Figure 1). Therefore, 28 studies [13][14][15][16]19,[21][22][23][24][25][26][27][28][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47] were eligible for inclusion and quality assessment.…”

“…Recently, a meta-analysis updated this risk to 1.53-fold for VTE and 3.69-fold for PE 20 but failed to include several observational studies. 13 , 21 – 25 In addition, studies that have recurrent VTE as the outcome were not included in the analysis. 26 – 28 …”