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Venous thromboembolism among elderly patients treated with atypical and conventional antipsychotic agents.

Abstract

BACKGROUND

Some antipsychotic agents have been indicated as a possible risk factor for venous thromboembolism (VTE) in adult patients with psychiatric disorders. The aim of this study was to estimate the effect of atypical and conventional antipsychotic agents on the risk of hospitalization for VTE among elderly patients.

METHODS

We conducted a retrospective cohort study on nursing home residents in 5 states. We used data from the Minimum Data Set to identify 19 940 new users of antipsychotic agents and 112 078 nonusers. Hospitalization with VTE as primary discharge diagnosis was determined during a 6-month follow-up period using Medicare inpatient claims. Cox proportional hazards models provided estimates of effect adjusted for confounders.

RESULTS

The rate of hospitalization for VTE was 0.91 per 100 person-years. Venous thrombosis accounted for 77.6% of events and 22.4% were pulmonary embolisms. Relative to nonusers, the rate of hospitalization for VTE was increased for users of atypical antipsychotic agents, including risperidone (adjusted hazard ratio [HR], 1.98; 95% confidence interval [CI], 1.40-2.78), olanzapine (adjusted HR, 1.87; 95% CI, 1.06-3.27), and clozapine and quetiapine fumarate (adjusted HR, 2.68; 95% CI, 1.15-6.28). No increased rate was associated with phenothiazines (adjusted HR, 1.03; 95% CI, 0.60-1.77) or other conventional agents (adjusted HR, 0.98; 95% CI, 0.52-1.87).

CONCLUSIONS

Atypical antipsychotic agents appear to increase the risk of VTE. However, these events are rare, and in clinical practice the absolute risk should be weighed against the effectiveness of these medications in the elderly population.

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  • Authors+Show Affiliations

    ,

    Centro di Medicina dell'Invecchiamento, Dipartimento di Scienze Gerontologiche, Geriatriche e Fisiatriche, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 80168 Rome, Italy. rossella_liperoti@rm.unicatt.it

    , , , ,

    Source

    MeSH

    Aged
    Aged, 80 and over
    Antipsychotic Agents
    Cohort Studies
    Female
    Hospitalization
    Humans
    Male
    Nursing Homes
    Proportional Hazards Models
    Pulmonary Embolism
    Retrospective Studies
    Thromboembolism
    United States
    Venous Thrombosis

    Pub Type(s)

    Journal Article
    Research Support, N.I.H., Extramural

    Language

    eng

    PubMed ID

    16344428

    Citation

    Liperoti, Rosa, et al. "Venous Thromboembolism Among Elderly Patients Treated With Atypical and Conventional Antipsychotic Agents." Archives of Internal Medicine, vol. 165, no. 22, 2005, pp. 2677-82.
    Liperoti R, Pedone C, Lapane KL, et al. Venous thromboembolism among elderly patients treated with atypical and conventional antipsychotic agents. Arch Intern Med. 2005;165(22):2677-82.
    Liperoti, R., Pedone, C., Lapane, K. L., Mor, V., Bernabei, R., & Gambassi, G. (2005). Venous thromboembolism among elderly patients treated with atypical and conventional antipsychotic agents. Archives of Internal Medicine, 165(22), pp. 2677-82.
    Liperoti R, et al. Venous Thromboembolism Among Elderly Patients Treated With Atypical and Conventional Antipsychotic Agents. Arch Intern Med. 2005;165(22):2677-82. PubMed PMID: 16344428.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Venous thromboembolism among elderly patients treated with atypical and conventional antipsychotic agents. AU - Liperoti,Rosa, AU - Pedone,Claudio, AU - Lapane,Kate L, AU - Mor,Vincent, AU - Bernabei,Roberto, AU - Gambassi,Giovanni, PY - 2005/12/14/pubmed PY - 2006/1/13/medline PY - 2005/12/14/entrez SP - 2677 EP - 82 JF - Archives of internal medicine JO - Arch. Intern. Med. VL - 165 IS - 22 N2 - BACKGROUND: Some antipsychotic agents have been indicated as a possible risk factor for venous thromboembolism (VTE) in adult patients with psychiatric disorders. The aim of this study was to estimate the effect of atypical and conventional antipsychotic agents on the risk of hospitalization for VTE among elderly patients. METHODS: We conducted a retrospective cohort study on nursing home residents in 5 states. We used data from the Minimum Data Set to identify 19 940 new users of antipsychotic agents and 112 078 nonusers. Hospitalization with VTE as primary discharge diagnosis was determined during a 6-month follow-up period using Medicare inpatient claims. Cox proportional hazards models provided estimates of effect adjusted for confounders. RESULTS: The rate of hospitalization for VTE was 0.91 per 100 person-years. Venous thrombosis accounted for 77.6% of events and 22.4% were pulmonary embolisms. Relative to nonusers, the rate of hospitalization for VTE was increased for users of atypical antipsychotic agents, including risperidone (adjusted hazard ratio [HR], 1.98; 95% confidence interval [CI], 1.40-2.78), olanzapine (adjusted HR, 1.87; 95% CI, 1.06-3.27), and clozapine and quetiapine fumarate (adjusted HR, 2.68; 95% CI, 1.15-6.28). No increased rate was associated with phenothiazines (adjusted HR, 1.03; 95% CI, 0.60-1.77) or other conventional agents (adjusted HR, 0.98; 95% CI, 0.52-1.87). CONCLUSIONS: Atypical antipsychotic agents appear to increase the risk of VTE. However, these events are rare, and in clinical practice the absolute risk should be weighed against the effectiveness of these medications in the elderly population. SN - 0003-9926 UR - https://www.unboundmedicine.com/medline/citation/16344428/Venous_thromboembolism_among_elderly_patients_treated_with_atypical_and_conventional_antipsychotic_agents_ L2 - https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/10.1001/archinte.165.22.2677 DB - PRIME DP - Unbound Medicine ER -