The Association and Influencing Factors between Antipsychotics Exposure and the Risk of VTE and PE: A Systematic Review and Meta-analysis

Dai, Luqi; Zuo, Qiunan; Chen, Fangying; Chen, Lei; Shen, Yongchun

doi:10.2174/1389450121666200422084414

Cited by 9 publications

(6 citation statements)

References 38 publications

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“…The occlusion/occlusion-like syndrome conceptual background as a large multicausal class effect, peripheral and central was realized only quite recently [ 1 , 2 , 3 , 4 , 5 , 6 , 7 ]. Here, there was a general cytoprotective endothelial threat (i.e., a disturbed dopamine system as a long-lasting essential pitfall in cytoprotection maintenance [ 30 , 31 , 32 , 33 , 34 , 35 ], endothelium lesions, and thrombosis induced by neuroleptics [ 36 , 37 , 38 , 39 , 40 , 41 ], domperidone [ 42 ], and amphetamine [ 43 , 44 , 45 ]). This accorded a major challenge of multicausal pathology (i.e., major vessel occlusion [ 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 ] peripherally and centrally and similar noxious procedures [ 19 , 20 , 21 , 22 , 23 , 24 ] severely affecting endothelium function).…”

Section: Introductionmentioning

confidence: 99%

Innate Vascular Failure by Application of Neuroleptics, Amphetamine, and Domperidone Rapidly Induced Severe Occlusion/Occlusion-like Syndromes in Rats and Stable Gastric Pentadecapeptide BPC 157 as Therapy

et al. 2023

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Even before behavioral disturbances, neuroleptics, amphetamine, and domperidone application rapidly emerged severe occlusion/occlusion-like syndrome, shared innate vascular and multiorgan failure in rats, comparable to occlusion/occlusion-like syndrome described with vessel(s) occlusion or similar noxious procedures application. As therapy, i.e., activation of the collateral pathways, “bypassing key” (activated azygos vein pathway, direct blood flow delivery), the stable gastric pentadecapeptide BPC 157 is a novel solution. Recently, BPC 157 therapy particularly counteracted neuroleptic- or L-NAME-induced catalepsy, lithium intoxication, and schizophrenia positive and negative symptoms (amphetamine/methamphetamine/apomorphine/ketamine). In rats with complete calvariectomy, medication (BPC 157 10 µg/kg, 10 ng/kg ip or ig) was given 5 min after distinctive dopamine agents (mg/kg ip) (haloperidol (5), fluphenazine (5), clozapine (10), risperidone (5), olanzapine (10), quetiapine (10), or aripiprazole (10), domperidone (25), amphetamine (10), and combined amphetamine and haloperidol) and assessed at 15 min thereafter. All neuroleptic-, domperidone-, and amphetamine-induced comparable vascular and multiorgan failure severe syndrome was alleviated with BPC 157 therapy as before major vessel(s) occlusion or other similar noxious procedures. Specifically, all severe lesions in the brain (i.e., immediate swelling, hemorrhage), heart (i.e., congestion, arrhythmias), and lung (i.e., congestion, hemorrhage), as well as congestion in the liver, kidney, and gastrointestinal (stomach) tract, were resolved. Intracranial (superior sagittal sinus), portal, and caval hypertension and aortal hypotension were attenuated or eliminated. BPC 157 therapy almost annihilated arterial and venous thrombosis, peripherally and centrally. Thus, rapidly acting Virchow triad circumstances that occur as dopamine central/peripheral antagonists and agonist essential class-points, fully reversed by BPC 157 therapy, might be overwhelming for both neuroleptics and amphetamine.

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Section: Introductionmentioning

confidence: 99%

Innate Vascular Failure by Application of Neuroleptics, Amphetamine, and Domperidone Rapidly Induced Severe Occlusion/Occlusion-like Syndromes in Rats and Stable Gastric Pentadecapeptide BPC 157 as Therapy

et al. 2023

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“… 39 On the other hand, they are both risk factors for VTE and vascular injury. 40 , 41 Second, smoking should not be ignored though this study did not collect the smoking-relevant information from the participants. Previous studies have reported that schizophrenia patients have extremely high prevalence of smoking compared to the general population and patients with other psychiatric diagnoses.…”

Section: Discussionmentioning

confidence: 99%

Hypercoagulable state in patients with schizophrenia: different effects of acute and chronic antipsychotic medications

Zheng,

Liu,

et al. 2023

Therapeutic Advances in Psychopharmacology

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Background: Previous studies reported higher incidences of venous thromboembolism and cardiovascular disease in schizophrenia patients and higher indicators of thrombosis, thrombocyte activation, and platelet dysfunction. Objectives: To check if first-episode schizophrenia (FES) patients have a hypercoagulable state and determine whether acute and chronic antipsychotics have the same effect on blood coagulation or fibrinolysis-related biomarkers. Design: Case-control study. Methods: A total of 81 participants were grouped in FES, chronic schizophrenia (CS), and healthy controls (HCs). In addition to demographic data and clinical characteristics, immunological analyses were performed to measure plasma levels of D-dimer, plasminogen activator inhibitor-1 (PAI-1), soluble P selectin (sP-sel), tissue plasminogen activator (tPA), thrombotic precursor protein (TpP), and von Willebrand’s disease factor (vWF). Results: Compared to HC group, FES patients showed higher PAI-1 (28.61 ng/ml versus 15.69 ng/ml), sP-sel (2.78 ng/ml versus 1.18 ng/ml), and TpP (15.61 µg/ml versus 5.59 µg/ml) along with a higher PAI-1/tPA (3.12 versus 2.00). Acute antipsychotic medication reduced higher PAI-1 (28.61 → 21.99), sP-sel (2.78 → 1.87), tPA (9.59 → 5.83), TpP (15.61 → 10.54), and vWF (383.18 → 291.08) in FES patients. However, plasma sP-sel and vWF in CS patients returned to the pre-treatment levels in FES patients, and PAI-1/tPA significantly decreased compared to FES patients. Conclusion: These results suggest a hypercoagulable state in FES patients and demonstrate contrast effects of acute and chronic antipsychotics on coagulation or fibrinolysis in schizophrenia patients.

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“…These findings are similar to those of previous reviews which found between 63.3% and 75% of patients were males [ 9 , 12 , 16 ]. In a meta-analysis that included a total of 31,514,226 subjects from 22 studies, Dai et al observed patients taking first- and second-generation antipsychotics [ 17 ]. These patients were at a higher risk of VTE than those who were not prescribed antipsychotics, and females taking antipsychotics had a higher risk of PE than males [ 17 ].…”

Section: Reviewmentioning

confidence: 99%

“…In a meta-analysis that included a total of 31,514,226 subjects from 22 studies, Dai et al observed patients taking first- and second-generation antipsychotics [ 17 ]. These patients were at a higher risk of VTE than those who were not prescribed antipsychotics, and females taking antipsychotics had a higher risk of PE than males [ 17 ]. In the same study, the authors reported that clozapine users have significantly increased VTE risk [ 17 ].…”

Section: Reviewmentioning

confidence: 99%

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Clozapine-Related Thromboembolic Events

Vela¹,

Dave²,

Cancarevic³

2021

Cureus

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Clozapine is an atypical antipsychotic used for treatment-resistant schizophrenia. Venous thromboembolism (VTE) is a rare side effect of clozapine which can be fatal. This article summarizes current evidence regarding the risk of VTE associated with the use of clozapine. We performed a PubMed (MeSH) and Google Scholar search for the last two decades. Studies or case reports performed in humans were included in the review, of which 42 case reports of patients taking clozapine at VTE onset were included in the analysis of this review. According to the articles reviewed, the mean age was 42.9 years, with more males (71.43%) than females (28.57%). The average clozapine dose was 285.62 mg/day. VTE onset occurred within the first six months in 71.8% of the cases. Overall, 70.37% of the patients had comorbidities, and 87.5% had risk factors for VTE. In total, 68.57% were prescribed other medications at VTE onset, and 60% were being treated with another antipsychotic concomitantly. Finally, 32.5% of the patients died, while 67.5% survived. In 60% of the cases, clozapine was discontinued after VTE. In our literature review, we observed that among clozapine users, VTE occurred at a wide dose range, and most of the events occurred within the first six months. As many patients who are prescribed clozapine have risk factors for VTE, the risk should be considered at the time of prescribing. Further research should be conducted to elucidate the risk of VTE in clozapine users and the benefits of thromboprophylaxis.

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The Association and Influencing Factors between Antipsychotics Exposure and the Risk of VTE and PE: A Systematic Review and Meta-analysis

Cited by 9 publications

References 38 publications

Innate Vascular Failure by Application of Neuroleptics, Amphetamine, and Domperidone Rapidly Induced Severe Occlusion/Occlusion-like Syndromes in Rats and Stable Gastric Pentadecapeptide BPC 157 as Therapy

Innate Vascular Failure by Application of Neuroleptics, Amphetamine, and Domperidone Rapidly Induced Severe Occlusion/Occlusion-like Syndromes in Rats and Stable Gastric Pentadecapeptide BPC 157 as Therapy

Hypercoagulable state in patients with schizophrenia: different effects of acute and chronic antipsychotic medications

Clozapine-Related Thromboembolic Events

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