Abstract
BackgroundOnly three observational studies investigated whether exposure to antipsychotics is associated with an increased risk of pulmonary embolism, with conflicting results. This study was therefore carried out to establish the risk of pulmonary embolism associated with antipsychotic drugs, and to ascertain the risk associated with first- and second-generation antipsychotic drugs, and with exposure to individual drugs.MethodsWe identified 84,253 adult individuals who began antipsychotic treatment in a large Italian health care system. Cases were all cohort members who were hospitalized for non-fatal or fatal pulmonary embolism during follow-up. Up to 20 controls for each case were extracted from the study cohort using incidence density sampling and matched by age at cohort entry and gender. Each individual was classified as current, recent or past antipsychotic user. The occurrence non-fatal or fatal pulmonary embolism was the outcome of interest.ResultsCompared to past use, current antipsychotic use more than double the risk of pulmonary embolism (odds ratio 2.31, 95% confidence interval 1.16 to 4.59), while recent use did not increase the risk. Both conventional and atypical antipsychotic exposure was associated with an increase in risk, and the concomitant use of both classes increased the risk of four times (odds ratio 4.21, 95% confidence interval 1.53 to 11.59).ConclusionsAdding the results of this case–control study to a recent meta-analysis of three observational studies substantially changed the overall estimate, which now indicates that antipsychotic exposure significantly increases the risk of pulmonary embolism.Electronic supplementary materialThe online version of this article (doi:10.1186/s12888-015-0479-9) contains supplementary material, which is available to authorized users.
Highlights
Three observational studies investigated whether exposure to antipsychotics is associated with an increased risk of pulmonary embolism, with conflicting results
Risk associated with AP drugs Compared to past use, current AP use more than double the risk of Pulmonary embolism (PE), while recent use did not increase with the risk of PE outcomes (Table 2)
Both conventional and atypical AP exposure was associated with an increase in risk, and the concomitant use of both AP classes increased the risk of four times
Summary
Three observational studies investigated whether exposure to antipsychotics is associated with an increased risk of pulmonary embolism, with conflicting results. This study was carried out to establish the risk of pulmonary embolism associated with antipsychotic drugs, and to ascertain the risk associated with first- and second-generation antipsychotic drugs, and with exposure to individual drugs. In 1997 Walker and colleagues conducted an epidemiological study suggesting that exposure to clozapine, an agent belonging to the group of the so-called secondgeneration antipsychotic (AP) drugs, significantly increased the risk of PE mortality [5]. We investigated whether exposure to AP drugs is associated with an increased risk of PE, and ascertained the risk associated with first- and secondgeneration AP drugs, and with exposure to individual drugs. We updated the published meta-analysis with the results of this study, using the same methodology
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