Antipsychotic Treatment and the Occurrence of Venous Thromboembolism

Wu, Chia-Fang; Lin, Chao-Cheng; Chang, Chia‐Ming; Wu, Kuan‐Lin; Liang, Hsin-Yi; Huang, Ya-Wen; Tsai, Hui‐Ju

doi:10.4088/jcp.12m08117

Cited by 32 publications

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“…Due to potential long‐term adverse consequences and increased health care costs, the continued use of antipsychotics should often be reevaluated, particularly at any transition of care. Long term consequences of antipsychotic use in patients over age 65 include metabolic syndrome, orthostasis, increased mortality from QT‐prolongation, ventricular arrhythmias, increased risk for falls, urinary infections, pneumonia, stroke, seizures, and venous thromboembolism . Also, patients with dementia are vulnerable to delirium, and antipsychotic use in this population carries a “black box warning” for all‐cause sudden death .…”

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confidence: 99%

“…Long term consequences of antipsychotic use in patients over age 65 include metabolic syndrome, orthostasis, increased mortality from QTprolongation, ventricular arrhythmias, increased risk for falls, urinary infections, pneumonia, stroke, seizures, and venous thromboembolism. [5][6][7][8] Also, patients with dementia are vulnerable to delirium, and antipsychotic use in this population carries a "black box warning" for all-cause sudden death. 9 Prolonged antipsychotic use not only increases the risk of adverse events but also increases health care costs.…”

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confidence: 99%

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Discharge Plans for Geriatric Inpatients with Delirium: A Plan to Stop Antipsychotics?

Johnson

Fashoyin

Madden‐Fuentes

et al. 2017

J American Geriatrics Society

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confidence: 99%

Discharge Plans for Geriatric Inpatients with Delirium: A Plan to Stop Antipsychotics?

Johnson

Fashoyin

Madden‐Fuentes

et al. 2017

J American Geriatrics Society

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“…Extrapyramidal effects include parkinsonism, dystonias, and oropharyngeal dysphagia leading to a marked increased risk of pneumonia (13). Increased risks have been demonstrated for potentially fatal complications including stroke, seizures, venous thromboembolism, QT-prolongation and ventricular arrhythmias (10, 14-16). The risk of sudden cardiac death is increased over 2.4-fold with both typical and atypical antipsychotic drugs (15).…”

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Doing damage in delirium: the hazards of antipsychotic treatment in elderly people

Inouye

Marcantonio

Metzger

2014

The Lancet Psychiatry

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“…This database stores data on demographic characteristics, clinical diagnoses, procedures, and prescription claims and has previously been used to study schizophrenia 30 and comparative effectiveness of antipsychotic drugs. 31,32 The study protocol was approved by the Research Ethics Committee of National Taiwan University Hospital, which provided a waiver of informed consent because the data used were deidentified. This study followed the if their first antipsychotic medication was a second-line regimen (eg, clozapine, polypharmacy, or long-acting injectables, which were not commonly used for incident cases in Taiwan over the study period).…”

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confidence: 99%

Development and Validation of a Machine Learning Individualized Treatment Rule in First-Episode Schizophrenia

et al. 2020

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IMPORTANCE Little guidance exists to date on how to select antipsychotic medications for patients with first-episode schizophrenia. OBJECTIVE To develop a preliminary individualized treatment rule (ITR) for patients with firstepisode schizophrenia. DESIGN, SETTING, AND PARTICIPANTS This prognostic study obtained data from Taiwan's National Health Insurance Research Database on patients with prescribed antipsychotic medications, ambulatory claims, or discharge diagnoses of a schizophrenic disorder between January 1, 2005, and December 31, 2011. An ITR was developed by applying a targeted minimum loss-based ensemble machine learning method to predict treatment success from baseline clinical and demographic data in a 70% training sample. The model was validated in the remaining 30% of the sample. The probability of treatment success was estimated for each medication for each patient under the model. The analysis was conducted between July 16, 2018, and July 15, 2019. EXPOSURES Fifteen different antipsychotic medications. MAIN OUTCOMES AND MEASURES Treatment success was defined as not switching medication and not being hospitalized for 12 months. RESULTS Among the 32 277 patients in the analysis, the mean (SD) age was 36.7 (14.3) years, and 15 752 (48.8%) were male. In the validation sample, the treatment success rate (SE) was 51.7% (1.0%) under the ITR and was 44.5% (0.5%) in the observed population (Z = 7.1; P < .001). The estimated treatment success if all patients were given a prescription for 1 medication was significantly lower for each of the 13 medications than under the ITR (Z = 4.2-16.8; all P < .001). Aripiprazole (3088 [31.9%]) and amisulpride (2920 [30.2%]) were the medications most often recommended by the ITR. Only 1054 patients (10.9%) received ITR-recommended medications. Observed treatment success, although lower than the success under the ITR, was nonetheless significantly higher than if medications had been randomized (44.5% [SE, 0.55%] vs 41.3% [SE, 0.4%]; Z = 6.9; P < .001), although only marginally higher than if medications had been randomized in their observed population proportions (44.5% [SE, 0.5%] vs 43.5% [SE, 0.4%]; Z = 2.2; P = .03]). CONCLUSIONS AND RELEVANCE These results suggest that an ITR may be associatded with an increase in the treatment success rate among patients with first-episode schizophrenia, but experimental evaluation is needed to confirm this possibility. If confirmed, model refinement that investigates biomarkers, clinical observations, and patient reports as additional predictors in iterative pragmatic trials would be needed before clinical implementation.

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Antipsychotic Treatment and the Occurrence of Venous Thromboembolism

Cited by 32 publications

References 0 publications

Discharge Plans for Geriatric Inpatients with Delirium: A Plan to Stop Antipsychotics?

Discharge Plans for Geriatric Inpatients with Delirium: A Plan to Stop Antipsychotics?

Doing damage in delirium: the hazards of antipsychotic treatment in elderly people

Development and Validation of a Machine Learning Individualized Treatment Rule in First-Episode Schizophrenia

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