Background Only 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. Methods We 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. Results Compared 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).
Conclusions Adding 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.
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While the risk of having serious heart problems is higher for those taking anti-Ps, none of the entirely retrospective surveys I have read have corrected for lifestyle issues common among those who take anti-Ps vs. the general population that doesn’t. This is like comparing baseballs to pomegranates: They’re both round, but that’s about it.
The average sz pt has a nice case of co-morbid PTSD going which means his or her body is subject to widely fluctuating serum cortisol levels and regular adrenaline flooding. (All ya gotta do to verify this is do a saliva test three times a day for two or three days.) The average schmoo who isn’t trying to make a life on dopamine suppression, under-stimulation and disability payments is not (nearly as) likely to have that problem.
In medium and large population studies, mental health pts who get training for Mindfulness-Based Stress Reduction, Stress Inoculation, Relaxation Response, Focused Breathing and other stress reduction practices have waaaaaaay more balanced serum cortisol levels… and less cardiovascular stress.
Dig around on PubMed; it’s all there.
What really bugs me about this study is that it doesn’t give any absolute risks. If the absolute risk goes from 1 out of 2,000 to 2 out of 2,000 its not a big deal. But its impossible to tell if the risk in either case is significant.
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Yeah, I saw that as well. I went looking for comp #s but couldn’t come up with anything quickly. Whatever the %age is for PE in the general pop, double it, I guess.
Ah - here are some numbers:
DVT and pulmonary embolism were relatively rare but more common in patients diagnosed with obesity. The numbers:
Obese patients with pulmonary embolism: 0.76% (91,000 of 12 million people)
Nonobese patients with pulmonary embolism: 0.34% (2.4 million of 691 million people)
So - perhaps something to be a little concerned about - but weight is a bigger issue I imagine.
Well, TG for low #s in the gen pop.
BUT… sz pts are four times as likely to be obese as the gen pop. Feh. http://psychcentral.com/news/2013/10/18/obesity-4-times-more-likely-in-schizophrenia-patients/60848.html. Thus, simple math says about eight times the gen pop rate or 0.34% x 8 = 2.72% for those who are obese… and 1/4 of that for those who are not.
Now. For those out there reading this, that’s still a very low degree of risk even if one is obese. I wouldn’t stop taking my meds.