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Is There an Association between Antipsychotic Medications and Venous Thromboembolism (VTE) in the Elderly?
Lynette Melgosa, Pharm D. Candidate
University of Colorado at Denver and Health Science Center
What Is a venous thromboembolism (VTE)
A VTE occurs when red blood cells, fibrin, and white blood cells form a clot within the blood vessels. Deep vein thrombosis (DVT) and pulmonary embolism (PE) represent different manifestations of a venous thromboembolism. Since the incidence of VTE increases with age, it is a major concern in elderly patients.
Findings from a new study suggest that treatment with atypical antipsychotic medications raises the risk of VTE in the elderly. The study did not find an increased rate of VTE with the other conventional agents (haloperidol, molindone) and phenothiazines (chlorpromazine, thioridazine). The study found 77.6% venous thrombosis events and 22.4% were pulmonary embolisms. The atypical antipsychotic agents they looked at were risperidone, olanzapine, clozapine, and quetiapine.
Risk Factors for a VTE
|
· major operations · trauma (fractures) · medical conditions · cancer and its treatment · stroke or paralysis · previous DVT · immobility/lack of movement · severe varicose veins |
· increasing age · pregnancy · some oral contraceptives · being overweight · smoking · thrombophilia · long journeys |
Signs & Symptoms of a deep vein thrombosis (DVT):
Signs & Symptoms of a pulmonary embolism (PE):
Atypical Antipsychotics
The study had some limitations which can lead to inconclusive evidence such as the population they studied was only from nursing home residents and also VTE events were selected on the basis of Medicare claims data which has the potential for misclassification of the outcomes. The study only confirmed patients that were hospitalized for a VTE and did not take into account fatality before hospitalization and all events that occurred without hospitalization.
Another limitation of the study was that it only looked at the elderly patients so we do not know if this evidence can apply to the younger population as well. Atypical antipsychotics have a common side effect of weight gain which being overweight is a risk factor for developing a VTE.
The findings of this study suggest that elderly patients taking atypical antipsychotics should be aware of this increase risk of VTE even though these events are low. Health care professionals and also those taking care of elderly patients on these medications need to be aware as well. We still need further research in order to have conclusive evidence. So therefore treatment decisions need to be based on individual risk profiles, needs, and the risk and benefits of both classes of antipsychotics.
References
1. Liperoti R, Pedone C, Lapane KL, Mor V, Bernabei R, Gambassi G. Venous Thromboembolism Among Elderly Patients Treated With Atypical and Conventional Antipsychotic Agents. Arch Intern Med 2005;165:2677-2682.
2. Guglielmo W, Koda-Kimble M, Kradjan W, Young L, editors. Handbook of Applied Therpeutics. Baltimore: Lippincott Williams and Wilkins; 2002.
3. Tierney L, Mcphee S, Papadakis M. 2005 Current Medical Diagnosis & Treatment: Adult Ambulatory & Inpatient Management. New York: McGraw Hill; 2005.
© 2006 Lynette Melgosa - Used By Permission
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Last updated June 14, 2007