Fatal pulmonary embolism in patients on antipsychotics: case series, systematic review and meta-analysis

MANOUBI, Syrine Azza; Boussaïd, Marwa; BRAHIM, Oumaima; Ouanes, Sami; MAHJOUB, Yosra; Zarrouk, L.; MESRATI, Mohamed Amin; AISSAOUI, Abir

doi:10.1016/j.ajp.2022.103105

Cited by 9 publications

(3 citation statements)

References 51 publications

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“…The occlusion/occlusion-like syndrome conceptual background as a large multicausal class effect, peripheral and central was realized only quite recently [ 1 , 2 , 3 , 4 , 5 , 6 , 7 ]. Here, there was a general cytoprotective endothelial threat (i.e., a disturbed dopamine system as a long-lasting essential pitfall in cytoprotection maintenance [ 30 , 31 , 32 , 33 , 34 , 35 ], endothelium lesions, and thrombosis induced by neuroleptics [ 36 , 37 , 38 , 39 , 40 , 41 ], domperidone [ 42 ], and amphetamine [ 43 , 44 , 45 ]). This accorded a major challenge of multicausal pathology (i.e., major vessel occlusion [ 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 ] peripherally and centrally and similar noxious procedures [ 19 , 20 , 21 , 22 , 23 , 24 ] severely affecting endothelium function).…”

Section: Introductionmentioning

confidence: 99%

Innate Vascular Failure by Application of Neuroleptics, Amphetamine, and Domperidone Rapidly Induced Severe Occlusion/Occlusion-like Syndromes in Rats and Stable Gastric Pentadecapeptide BPC 157 as Therapy

et al. 2023

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Even before behavioral disturbances, neuroleptics, amphetamine, and domperidone application rapidly emerged severe occlusion/occlusion-like syndrome, shared innate vascular and multiorgan failure in rats, comparable to occlusion/occlusion-like syndrome described with vessel(s) occlusion or similar noxious procedures application. As therapy, i.e., activation of the collateral pathways, “bypassing key” (activated azygos vein pathway, direct blood flow delivery), the stable gastric pentadecapeptide BPC 157 is a novel solution. Recently, BPC 157 therapy particularly counteracted neuroleptic- or L-NAME-induced catalepsy, lithium intoxication, and schizophrenia positive and negative symptoms (amphetamine/methamphetamine/apomorphine/ketamine). In rats with complete calvariectomy, medication (BPC 157 10 µg/kg, 10 ng/kg ip or ig) was given 5 min after distinctive dopamine agents (mg/kg ip) (haloperidol (5), fluphenazine (5), clozapine (10), risperidone (5), olanzapine (10), quetiapine (10), or aripiprazole (10), domperidone (25), amphetamine (10), and combined amphetamine and haloperidol) and assessed at 15 min thereafter. All neuroleptic-, domperidone-, and amphetamine-induced comparable vascular and multiorgan failure severe syndrome was alleviated with BPC 157 therapy as before major vessel(s) occlusion or other similar noxious procedures. Specifically, all severe lesions in the brain (i.e., immediate swelling, hemorrhage), heart (i.e., congestion, arrhythmias), and lung (i.e., congestion, hemorrhage), as well as congestion in the liver, kidney, and gastrointestinal (stomach) tract, were resolved. Intracranial (superior sagittal sinus), portal, and caval hypertension and aortal hypotension were attenuated or eliminated. BPC 157 therapy almost annihilated arterial and venous thrombosis, peripherally and centrally. Thus, rapidly acting Virchow triad circumstances that occur as dopamine central/peripheral antagonists and agonist essential class-points, fully reversed by BPC 157 therapy, might be overwhelming for both neuroleptics and amphetamine.

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Section: Introductionmentioning

confidence: 99%

Innate Vascular Failure by Application of Neuroleptics, Amphetamine, and Domperidone Rapidly Induced Severe Occlusion/Occlusion-like Syndromes in Rats and Stable Gastric Pentadecapeptide BPC 157 as Therapy

et al. 2023

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“…Many studies have shown the strong relationship between mental illness, antipsychotic medication, and PTE, whereas the underlying mechanisms are remained poorly understood. [19][20][21] The increased venous blood stasis in mental patients might be attributed to the high levels of p-selectin and Factor VIII and the constant patient restriction during the psychotic episode. 22 A recent study demonstrates that clozapine promotes thrombosis by binding fibrinogen and affecting fibrin formation.…”

Section: Discussionmentioning

confidence: 99%

Forensic Pathological Analysis of Death Due to Pulmonary Thromboembolism

Chen¹,

Wang²,

Zhang

et al. 2023

Am J Forensic Med Pathol

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Pulmonary thromboembolism (PTE) is a common cause of sudden unexpected death in forensic and clinical practice. Although the prevention of thrombosis has been paid more attention in clinical practice in recent years, the number of deaths due to PTE remains extensive. In the present study, 145 cases of fatal PTE were collected and retrospectively analyzed from 2001 to 2020 at the School of Forensic Medicine, China Medical University in Liaoning Province, northeast of China. The demographic characteristics, risk factors of PTE, origins of thrombi, and time interval from the occurrence of main risk factors to PTE were retrospectively analyzed. The 40 to 59 age group accounted for the 51.0% of the total cases. Immobilization, trauma (especially fracture of the pelvis, femur, tibia, or fibula), surgery, cesarean section, and mental disorders were the top 5 high-risk factors. Among the involved cases, 92.9% of the PTE (130/140) occurred within 60 days and peak at 8 to 15 days after the exposure of main risk factors. According to the autopsy findings, 87.6% of the thrombi blocked the bilateral pulmonary arteries at pulmonary hilus, with a maximum diameter of 1.6 cm and a maximum length of 21.9 cm, which were mainly derived from lower limb (65.5%) or pelvic veins (10.3%). Although the embolus limited the pulmonary circulation, there is no difference on the ratio of lung-to-heart weight between PTE and the disease-free accident victims. Overall, our present retrospective study provides important information for the forensic analysis on the cause of death and potential guidance on clinical prevention of PTE.

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“…Restrictions on daily activities in patients with MDs can increase the risk of developing VTE, similar to that while taking antipsychotropic drugs. 11 Olanzapine, an antipsychotic, has been associated with antiphospholipid syndrome. 19 In the present study, 6 patients with MDs were prescribed olanzapine, although they did not have a definitive diagnosis of antiphospholipid syndrome.…”

Section: Advance Publication the Previous Findingmentioning

confidence: 99%

Detrimental Impact of Comorbid Mental Disorders in Chronic Thromboembolic Pulmonary Hypertension　― A Retrospective Observational Study ―

Adachi,

Nakano

et al. 2024

Circ Rep

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Background: The relationship between the prognosis of patients with both chronic thromboembolic pulmonary hypertension (CTEPH) and a mental disorder (MD) remains unclear. Methods and Results: The study group comprised 157 patients with CTEPH who underwent right heart catheterization and were subdivided into 2 groups according to the presence of MDs: MD and non-MD. The patients with MDs were defined as those who had visited a psychiatrist and were under psychotropic drug treatment. The primary outcome was a composite of all-cause death and worsening of PH. The median follow-up period was 1,164 days. The incidence of the primary composite outcome was higher in the MD group than in the non-MD group (24.0% vs. 6.8%), whereas the all-cause mortality rate was comparable between groups (12.0% vs. 6.1%). The mean pulmonary arterial pressure, cardiac index, and pulmonary vascular resistance at baseline were all similar between groups. The Cox proportional hazards model indicated that MD was an independent risk factor for the primary composite outcome (hazard ratio, 2.990; 95% confidence interval, 1.034–8.642). Conclusions: In the present study, concomitant CTEPH and MD was significantly associated with a poor prognosis and such patients should be carefully followed.

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Fatal pulmonary embolism in patients on antipsychotics: case series, systematic review and meta-analysis

Cited by 9 publications

References 51 publications

Innate Vascular Failure by Application of Neuroleptics, Amphetamine, and Domperidone Rapidly Induced Severe Occlusion/Occlusion-like Syndromes in Rats and Stable Gastric Pentadecapeptide BPC 157 as Therapy

Innate Vascular Failure by Application of Neuroleptics, Amphetamine, and Domperidone Rapidly Induced Severe Occlusion/Occlusion-like Syndromes in Rats and Stable Gastric Pentadecapeptide BPC 157 as Therapy

Forensic Pathological Analysis of Death Due to Pulmonary Thromboembolism

Detrimental Impact of Comorbid Mental Disorders in Chronic Thromboembolic Pulmonary Hypertension　― A Retrospective Observational Study ―

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Fatal pulmonary embolism in patients on antipsychotics: case series, systematic review and meta-analysis

Cited by 9 publications

References 51 publications

Innate Vascular Failure by Application of Neuroleptics, Amphetamine, and Domperidone Rapidly Induced Severe Occlusion/Occlusion-like Syndromes in Rats and Stable Gastric Pentadecapeptide BPC 157 as Therapy

Innate Vascular Failure by Application of Neuroleptics, Amphetamine, and Domperidone Rapidly Induced Severe Occlusion/Occlusion-like Syndromes in Rats and Stable Gastric Pentadecapeptide BPC 157 as Therapy

Forensic Pathological Analysis of Death Due to Pulmonary Thromboembolism

Detrimental Impact of Comorbid Mental Disorders in Chronic Thromboembolic Pulmonary Hypertension ― A Retrospective Observational Study ―

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Detrimental Impact of Comorbid Mental Disorders in Chronic Thromboembolic Pulmonary Hypertension　― A Retrospective Observational Study ―