Atypical Antipsychotic Drugs and the Risk for Acute Kidney Injury and Other Adverse Outcomes in Older Adults

Hwang, Y. Joseph; Dixon, Stephanie N.; Reiss, Jeffrey P.; Wald, Ron; Parikh, Chirag R.; Gandhi, Sumeet; Shariff, Salimah Z.; Pannu, Neesh; Nash, Danielle M.; Rehman, Faisal; Garg, Amit X.

doi:10.7326/m13-2796

Cited by 120 publications

(108 citation statements)

References 31 publications

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“…These databases have been used extensively to research health outcomes and health services. [14][15][16][17][18][19][20] These databases were held securely in a linked, de-identified form at ICES and analyzed at the ICES Western site.…”

Section: Methods Study Designmentioning

confidence: 99%

Disparities in surgery among patients with intractable epilepsy in a universal health system

et al. 2016

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Objective: To assess the use of epilepsy surgery in patients with medically intractable epilepsy in a publicly funded universal health care system. Methods:We performed a population-based retrospective cohort study using linked health care databases for Ontario, Canada, between 2001 and 2010. We identified all patients with medically intractable epilepsy, defined as those with seizures that did not respond to at least 2 adequate trials of seizure medications. We assessed the proportion of patients who had epilepsy surgery within the following 2 years. We further identified the characteristics associated with epilepsy surgery.Results: A total of 10,661 patients were identified with medically intractable epilepsy (mean age 47 years, 51% male); most (74%) did not have other comorbidities. Within 2 years of being defined as medically intractable, only 124 patients (1.2%) underwent epilepsy surgery. Death occurred in 12% of those with medically intractable epilepsy. Those who underwent the procedure were younger and had fewer comorbidities compared to those who did not. Conclusion:In our setting of publicly funded universal health care, more than 10% of patients died within 2 years of developing medically intractable epilepsy. Epilepsy surgery may be an effective treatment for some patients; however, fewer than 2% of patients who may have benefited from epilepsy surgery received it.

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Section: Methods Study Designmentioning

confidence: 99%

Disparities in surgery among patients with intractable epilepsy in a universal health system

et al. 2016

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“…However, our review identified two additional studies (Wang, 2011;Hwang et al, 2014) and pooled all risk estimates. Studies conducted before 2006 (Thorogood et al 1992, Penttinen and Valonen 1996, Pratt et al 1996, Enger et al 2004) were rated as low quality based on NOS scores.…”

Section: Discussionmentioning

confidence: 99%

“…AP use may merely be a marker for the presence of cardiovascular risk factors and not the reason for MI; alternately, APs may interact with state-dependent risk factors through unknown mechanisms to trigger MI. With regards to the non-significant elevation (Brauer et al, 2015;Pariente et al, 2012) in the risk of MI in long-term APs users, since the development of atherosclerotic plaque takes a period of years to decades, the mean follow-up time from participants in the analyzed cohort studies (approximately 6.5 years with the range of 1-13 years) (Enger et al, 2004;Hwang et al, 2014;Pariente et al, 2012;Pratt et al, 1996) may be insufficient for AP to meaningfully affect the MI process.…”

Section: Discussionmentioning

confidence: 99%

“…One studies (Brauer et al, 2015;Pariente et al, 2012) analyzed twodifferent types of study design: Brauer et al (2015) used the self-controlled case series and case-control study design to investigate the association between MI risk and AP use.We found four case-control studies (Brauer et al, 2015;Nakagawa et al, 2006;Penttinen and Valonen, 1996;Thorogood et al, 1992), two case-crossover studies (Wu et al, 2015b;Lin et al, 2014), one case-case time control study (Wang, 2011), Threecohort studies (Enger et al, 2004;Hwang et al, 2014;Pariente et al, 2012;Pratt et al, 1996) and oneself-controlled case series (Brauer et al, 2015;Pariente et al, 2012). The countries where the studies had been performed were Finland, Denmark, UK, Canada, Taiwan, and USA,and the range of study enrolment periods was 1980-2012.…”

Section: Study Selectionmentioning

confidence: 99%

“…Among, the nine studies they identified, only two (Brauer et al, 2015;Pariente et al, 2012) provided separate estimates for different time windows after AP initiation. Besides, a more recently published study (Hwang et al, 2014) was not included in their meta-analysis. It is widely recognized that systematic reviews of randomized controlled trials (RCTs) represent the most reliable and appropriate reference standard to address questions of effectiveness, as they are designed to minimize bias.…”

Section: Introductionmentioning

confidence: 99%

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Myocardial infarction risk and antipsychotics use revisited: a meta-analysis of 10 observational studies

et al. 2017

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Objective: Associations between antipsychotic agent (AP) use and myocardial infarction (MI) risk have been inconsistent and remain controversial. We therefore conducted a meta-analysis of observational studies to address this knowledge gap.Method: Detailed electronic database searches were performed to identify reports of observational studies that evaluated the association between AP use and the risk of MI.Pooled odds ratios were calculated using random or fixed-effects models. Results:In total, 4 case-control studies, 2 case-crossover studies, 1 case-case time control study, 3 cohort studies, and 1 self-controlled case serieswere included. The pooled odds ratio (95% CIs) between any AP use and MI risk was 1.55 (1.33-1.79) compared with non-use: 1.39 (1.06-1.82) for atypical AP use and 1.57 (1.29-1.91) for typical AP use. Subgroup analyses indicated that male gender, schizophrenia diagnosis and AP exposure periods ≦60 days, but not prior cardiovascular disease diagnosisor older age, were associated with higher risk of MI. Conclusion:Current evidence, based on 10 observational studies, suggested that AP use might be a potential risk factor of MI. However, we cannot conclude at this time due to significant heterogeneity among studies. We suggest that, instead of not using APs in fear of the risk, careful cardiovascular monitoring before and during AP treatment in high-risk patients group is needed. Additional high-quality prospective studies are required to evaluate the association between APs and the risk of MI.

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Prophylactic Haloperidol for Critically Ill Adults

Torbic

Duggal

2018

JAMA

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Atypical Antipsychotic Drugs and the Risk for Acute Kidney Injury and Other Adverse Outcomes in Older Adults

Abstract: Academic Medical Organization of Southwestern Ontario.

Cited by 120 publications

References 31 publications

Disparities in surgery among patients with intractable epilepsy in a universal health system

Disparities in surgery among patients with intractable epilepsy in a universal health system

Myocardial infarction risk and antipsychotics use revisited: a meta-analysis of 10 observational studies

Prophylactic Haloperidol for Critically Ill Adults

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