Psychotropic drugs and fatal pulmonary embolism

Parkin, Lianne; Skegg, D. C. G.; Herbison, Peter; Paul, Charlotte

doi:10.1002/pds.841

Cited by 75 publications

(75 citation statements)

References 14 publications

(16 reference statements)

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“…The focus of the present analysis was on antidepressants, but we also found a significantly increased risk of VTE associated with use of other psychotropic drugs, which is consistent with findings from the previous reports that examined this association 7, 11, 12, 13, 29, 30…”

Section: Discussionsupporting

confidence: 91%

“…Of 5 studies with prospectively collected exposure information,7, 8, 9, 10, 11 a significant relationship between antidepressant use and VTE was reported in 3 (which was largely confined to users of tricyclic products)7, 8, 9 and the findings from one other was consistent with our findings, with wide CIs 11. The fifth study found no association,10 but the comparison group included patients taking thyroid replacement hormones, patients with a history of VTE or cancer were only excluded if diagnosed in the 36 months before cohort entry, follow‐up was not censored at cancer diagnosis or surgery, and no adjustment for body mass index, smoking, or physical activity was performed.…”

Section: Discussionmentioning

confidence: 99%

“…The prevalence of antidepressant use in some populations is high; for example, the 2013 Health Survey of England found that antidepressants had been used in the previous week by 11% of women and 6% of men aged 16 years and older,5 while the 2005–2008 National Health and Nutrition Examination Surveys in the United States reported figures of 15% and 6% for females and males, respectively, aged 12 years and older 6. A few studies have found a significant relationship between antidepressant use and VTE,7, 8, 9 whereas others have not 10, 11, 12, 13. In addition, 2 studies reported an association between depression and VTE risk, although only one investigated antidepressant use 14, 15.…”

Section: Introductionmentioning

confidence: 99%

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Antidepressants, Depression, and Venous Thromboembolism Risk: Large Prospective Study of UK Women

Parkin

Balkwill

Sweetland

et al. 2017

JAHA

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BackgroundSome 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 ResultsThe 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).ConclusionsUse of antidepressants is common in UK women and is associated with an increased risk of VTE.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Antidepressants, Depression, and Venous Thromboembolism Risk: Large Prospective Study of UK Women

Parkin

Balkwill

Sweetland

et al. 2017

JAHA

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“…The association between conventional antipsychotics and VTE was investigated in 8 observational studies, listed in Table I [3][4][5][6][7][8][9][10] . Two studies suggest a positive association between conventional antipsychotics and VTE but are inconclusive (due to small numbers of patients) 3,8 .…”

Section: Psychotropic Drugsmentioning

confidence: 99%

Deep venous thrombosis and pulmonary embolism in psychiatric settings

Neste¹,

Verbruggen²,

Leysen³

2009

Eur. J. Psychiat.

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“…5 7 Parkin et al used a New Zealand national death registry to identify adults under age 60 and without established risk factors and tracked deaths caused by pulmonary embolism between 1990 and 1998. 5 Zornberg and Jick defined cases as all venous thromboembolic events requiring hospitalisation for anticoagulation and drew participants from the UK general practice research database of three million patients. 7 None of the observational data can provide definitive evidence of a casual [causal?…”

Section: Asking a Questionmentioning

confidence: 99%

Pulmonary embolism in a patient taking clozapine

Srihari

Lee

2008

BMJ

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A 45 year old man with schizophrenia began experiencing auditory hallucinations at the age of 25. These were well controlled for several years by a monthly intramuscular injection of haloperidol decanoate. One year after he switched to oral haloperidol, the intensity of the hallucinations increased and included a voice commanding him to end his life. Concerns for his safety led to a brief admission to psychiatric hospital. When he had to return to hospital within a month, the inpatient psychiatrist inferred a loss of response to haloperidol and encouraged the patient to switch to clozapine. Six months later he was brought to an emergency department in an acute confusional state after a clozapine overdose. The drug was discontinued and his mental status improved rapidly, but investigation of acute dyspnoea showed bilateral pulmonary emboli. The patient was not overweight and had no history of recent surgery, trauma to the legs, or malignancy, but he was a heavy smoker. Laboratory tests for hypercoagulable states had negative results. He was treated with intravenous heparin and then oral warfarin and was transferred to a psychiatric unit for resumption of treatment with clozapine.

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Psychotropic drugs and fatal pulmonary embolism

Abstract: Our results for conventional antipsychotics are consistent with previous studies of non-fatal venous thromboembolism. The finding for antidepressants needs to be replicated in other studies.

Cited by 75 publications

References 14 publications

Antidepressants, Depression, and Venous Thromboembolism Risk: Large Prospective Study of UK Women

Antidepressants, Depression, and Venous Thromboembolism Risk: Large Prospective Study of UK Women

Deep venous thrombosis and pulmonary embolism in psychiatric settings

Pulmonary embolism in a patient taking clozapine

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