Thromb Haemost 2002; 88(02): 205-209
DOI: 10.1055/s-0037-1613188
In Focus
Schattauer GmbH

Antipsychotic and Antidepressant Drug Use in the Elderly and the Risk of Venous Thromboembolism

Joel G. Ray
1   Department of Medicine, Sunnybrook and Women’s College Health Sciences Centre, Toronto, Ontario
,
Muhammad M. Mamdani
2   Institute for Clinical Evaluation Sciences, University of Toronto, Toronto, Ontario
3   Faculty of Pharmacy, University of Toronto, Toronto, Ontario
,
Erik L. Yeo
4   Department of Medicine, University Health Network, Toronto, Ontario, Canada
› Institutsangaben
Funding source Thrombosis Research Fund, University Health Network, Toronto, Ontario, and the Institute for Health Economics, Edmonton, Alberta
Weitere Informationen

Publikationsverlauf

Received 09. Januar 2002

Accepted after revision 11. April 2002

Publikationsdatum:
07. Dezember 2017 (online)

Summary

Background

Preliminary evidence suggests that use of antipsychotic drugs is associated with an increased risk of venous thromboembolism.

Objective

To evaluate the relationship between antipsychotic or antidepressant drug use and venous thromboembolism among adults aged 65 years and older.

Design

Retrospective cohort study using linked health care administrative databases over a nine year period.

Setting

The entire province of Ontario, Canada.

Participants

Individuals aged 65 years and over exclusively prescribed either antipsychotic drugs (n = 22514), antidepressant drugs (n = 75649) or thyroid replacement hormones (33033), the referent control group. We excluded those with an antecedent history of cardiovascular disease, venous thromboembolism or cancer, as well as those dispensed warfarin before study entry.

Measurements

Diagnosis of deep vein thrombosis or pulmonary embolism.

Results

Relative to those prescribed thyroid hormones, neither anti-depressant (adjusted hazard ratio 1.02, 95% CI 0.91-1.14) nor anti-psychotic (adjusted hazard ratio 1.13, 95% CI 0.96-1.32) drug use was associated with an increased risk for deep vein thrombosis. Similar risk estimates were found for deep vein thrombosis or pulmonary embolism. In a sub-group analysis, only butyrophenone use was found to be associated with a slightly increased risk of deep vein thrombosis (adjusted HR 1.51, 95% CI 1.23-1.86) as well as deep vein thrombosis or pulmonary embolism (adjusted HR 1.43, 95% CI 1.18-1.74).

Conclusions

In a large cohort of adults aged 65 years and older, neither antipsychotic or antidepressant drug use was associated with an increased risk of venous thromboembolism, with the exception of a slightly increased risk among those prescribed butyrophenones. Further data are required before use of these psychoactive drugs can be considered a risk factor for venous thromboembolism.

 
  • References

  • 1 Meier-Ewert K, Baumgart HH, Friedenberg P. Thromboembolische Komplikationen bei neuro- und thymoleptischer Behandlung. Dtsch Med Wschr 1967; 47: 2174-8.
  • 2 Pantel J, Schroder J, Eysenbach K, Mundt C. Two cases of deep vein thrombosis associated with a combined paroxetine and zotepine therapy. Pharmacopsychiatry 1997; 30: 109-11.
  • 3 Varia I, Krishnan RR, Davidson J. Deep-vein thrombosis with antipsychotic drugs. Psychosomatics 1983; 24: 1097-8.
  • 4 Zornberg GL, Jick H. Antipsychotic drug use and risk of first-time idiopathic venous thromboembolism: a case-control study. Lancet 2000; 356: 1219-23.
  • 5 Silverstein MD, Heit JA, Mohr DN, Petterson TM, O’Fallon WM, Melton 3rd LJ. Trends in the incidence of deep vein thrombosis and pulmonary embolism: a 25-year population-based study. Arch Intern Med 1998; 158: 585-93.
  • 6 Thomassen R, Vandenbroucke JP, Rosendaal FR. Antipsychotic medication and venous thrombosis. Br J Psychiatry 2001; 179: 63-6.
  • 7 Kraaijenhagen RA, Lensing AW, Wallis JW, van Beek EJ, ten Cate JW, Buller HR. Diagnostic management of venous thromboembolism. Baillieres Clin Haematol 1998; 11: 541-86.
  • 8 Pressley JC, Patrick CH. Frailty bias in comorbidity risk adjustments of community-dwelling elderly populations. J Clin Epidemiol 1999; 52: 753-60.
  • 9 Grady D, Wenger NK, Herrington D, Khan S, Furberg C, Hunninghake D, Vittinghoff E, Hulley S. Postmenopausal hormone therapy increases risk for venous thromboembolic disease. The Heart and Estrogen/progestin Replacement Study. Ann Intern Med 2000; 132: 689-96.
  • 10 Landi F, Gambassi G, Lapane KL, Sgadari A, Gifford D, Mor V. et al. Comorbidity and drug use in cognitively impaired elderly living in long-term care. Dement Geriatr Cogn Disord 1998; 09: 347-56.
  • 11 Selikson S, Damus K, Hamerman D. Risk factors associated with immobility. J Am Geriatr Soc 1988; 36: 707-12.
  • 12 Sorensen L, Foldspang A, Gulmann NC, Munk-Jorgensen P. Determinants for the use of psychotropics among nursing home residents. Int J Geriatr Psychiatry 2001; 16: 147-54.
  • 13 Burgio LD, Hawkins AM. Behavioral assessment of the effects of psychotropic medications on demented nursing home residents. Behav Modif 1991; 15: 194-212.
  • 14 Bueno-Cavanillas A, Padilla-Ruiz F, Jimenez-Moleon JJ, Peinado-Alonso CA, Galvez-Vargas R. Risk factors in falls among the elderly according to extrinsic and intrinsic precipitating causes. Eur J Epidemiol 2000; 16: 849-59.
  • 15 Ray WA, Griffin MR, Malcolm E. Cyclic antidepressants and the risk of hip fracture. Arch Intern Med 1991; 151: 754-6.
  • 16 Wolstein J, Grohmann R, Ruther E. Antipsychotic drugs and venous thromboembolism. Lancet 2000; 356: 252.
  • 17 Greenland S, Schwartzbaum JA, Finkle WD. Problems due to small samples and sparse data in conditional logistic regression analysis. Am J Epidemiol 2000; 151: 531-9.
  • 18 Iezzoni LI, Foley SM, Daley J, Hughes J, Fisher ES, Heeren T. Comorbidities, complications, and coding bias: does the number of diagnosis codes matter in predicting in-hospital mortality?. JAMA 1992; 267: 2197-203.
  • 19 Ray JG. Neuroleptic malignant syndrome associated with severe thrombocytopenia. J Intern Med 1997; 241: 245-7.
  • 20 Ghani SO, Ahmed W, Marco LA. Neuroleptic malignant syndrome and severe thrombocytopenia: case report and literature review. Ann Clin Psychiatry 2000; 12: 51-4.
  • 21 Metzer WS, Canoso RT, Newton JE. Anticardiolipin antibodies in a sample of chronic schizophrenics receiving neuroleptic therapy. South Med J 1994; 87: 190-2.
  • 22 Susser E, Brown AS, Klonowski E, Allen RH, Lindenbaum J. Schizophrenia and impaired homocysteine metabolism: a possible association. Biol Psychiatry 1998; 44: 141-3.
  • 23 Penninx BW, Guralnik JM, Ferrucci L, Fried LP, Allen RH, Stabler SP. Vitamin B(12) deficiency and depression in physically disabled older women: epidemiologic evidence from the Women’s Health and Aging Study. Am J Psychiatry 2000; 157: 715-21.
  • 24 Ray JG. A meta-analysis of hyperhomocyst(e)inemia and the risk of venous thromboembolic disease. Arch Intern Med 1998; 158: 2101-6.
  • 25 Samama MM, Cohen AT, Darmon JY, Desjardins L, Eldor A, Janbon C. et al. A comparison of enoxaparin with placebo for the prevention of venous thromboembolism in acutely ill medical patients. Prophylaxis in Medical Patients with Enoxaparin Study Group. N Engl J Med 1999; 341: 793-800.
  • 26 Drug Benefit Formulary. Ontario Ministry of Health and Long-Term Care. December 2000