Antipsychotic medications and stroke in schizophrenia: A case-crossover study

Abstract
Background

The association between antipsychotic use and the risk of stroke in schizophrenic patients is controversial. We sought to study the association in a nationwide cohort with schizophrenia.
Methods

Using a retrospective cohort of patients with schizophrenia (N = 31,976) derived from the Taiwan National Health Insurance Research Database, 802 new-onset cases of stroke were identified within 10 years of follow-up (from 2000 through 2010). We designed a case-crossover study using 14-day windows to explore the risk factors of stroke and the association between antipsychotic drugs and the risk of stroke. We analyzed the risks of individual antipsychotics on various subgroups of stroke including ischemic, hemorrhagic, and other strokes, and the risks based on the antipsychotic receptor-binding profile of each drug.
Results

Use of any second-generation antipsychotic was associated with an increased risk of stroke (adjusted risk ratio = 1.45, P = .009) within 14 days while the use of any first-generation antipsychotic was not. Intriguingly, the use of any second-generation antipsychotic was associated with ischemic stroke but not hemorrhagic stroke. The antipsychotic receptor-binding profile analysis showed that the antihistamine 1 receptor was significantly associated with ischemic stroke (adjusted risk ratio = 1.72, P = .037), and the sensitivity analysis based on the 7-day window of exposure validated the association (adjusted risk ratio = 1.87, P = .015).
Conclusions

Use of second-generation antipsychotic drugs appeared to be associated with an increased risk of ischemic stroke in the patients studied, possibly mediated by high affinity for histamine-1 receptor blockade. Further research regarding the underlying biological mechanism and drug safety is suggested.

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I’ve taken second-generation antipsychotics for 34 years, and I’ve had two ischemic strokes in the last 5 years. My physician cannot find a reason for the strokes (I’ve had all kinds of scans), so I’m going to tell her about this study.

Thanks, @firemonkey

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This gives me something to consider with my Inner Ear Tumor treatments.

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i take 2 first gen APs and just started taking abiify a second gen drug but this study may make me think twice about staying on ablify. Thank you for sharing this.

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Is ischemic stroke mean u have blockage, vs hemorrhagic is blood vessels burst? Also kindness u should consider lifestyle things such as smoking diabetes weight excersise etc all these things can contribute as well as AP

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This is another reason to stay on my first-generation antipsychotic then.

@Esm

A Transient Ischemic Attack (TIA) is a blockage, or partial blockage, of blood flow to the brain.

The difference between a TIA and a stroke is that in a TIA the blockage breaks up by itself in a relatively short amount of time ( typically a few minutes), and the person incurs no permanent damage.

I take 325 mg of aspirin a day, but you’re right that I would benefit from lifestyle changes.

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