Phenothiazine-Associated Lupus Anticoagulant and Thrombotic Disease

El‐Mallakh, Rif S.; Donaldson, James O.; Kranzler, Henry R.; Racy, Anis

doi:10.1016/s0033-3182(88)72430-5

Cited by 12 publications

(4 citation statements)

References 23 publications

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“…Raised levels of antiphospholipid antibodies (APLs) including lupus anticoagulants and anticardiolipin antibodies are established risk factors of VTE, and have been observed in patients treated with first-generation antipsychotics [69][70][71][72][73][74][75][76][77] and clozapine [78,79]. However, elevated titres have also been found in large proportions of unmedicated psychotic patients [73,80,81].…”

Section: Biological Mechanismsmentioning

confidence: 99%

Risk of venous thromboembolism due to antipsychotic drug therapy

Hägg

Jönsson

Spigset

2009

Expert Opinion on Drug Safety

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An increasing number of reports suggest a link between venous thromboembolism (VTE) and the use of antipsychotics. To better understand this association the available body of evidence has been critically scrutinised. Relevant articles were identified in the databases Scopus and PubMed. Several observational studies using different methodologies show an increased risk of VTE in psychiatric patients. This elevated risk seems to be related to the use of antipsychotic medication and in particular to the use of clozapine and low-potency firstgeneration drugs. Many studies investigating the association have, however, methodological limitations. The biological mechanisms involved in the pathogenesis of this possible adverse reaction are largely unknown but several hypotheses have been suggested such as druginduced sedation, obesity, increased levels of antiphospholipid antibodies, enhanced platelet aggregation, hyperhomocysteinemia and hyperprolactinemia. The association may also be related to underlying risk factors present in psychotic patients. Physicians need to be aware of this possible adverse drug reaction. Although supporting evidence has not been published they should consider discontinuing or switching the antipsychotic treatment in patients experiencing VTE. In addition, although data is lacking, the threshold for considering prophylactic antithrombotic treatment should be low when risk situations for VTE arise, such as immobilisation, surgery and so on.

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Section: Biological Mechanismsmentioning

confidence: 99%

Risk of venous thromboembolism due to antipsychotic drug therapy

Hägg

Jönsson

Spigset

2009

Expert Opinion on Drug Safety

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“…Chlorpromazine is the most frequent culprit with over 300 cases reported [14,18,31,32,[39][40][41][42][43][44][45][46][47][48][49][50][51][52][53][54][55]. The first report of a phenothiazine-induced LA (PZILA) was published in 1977 by Canoso and Hutton [39].…”

Section: Phenothiazinesmentioning

confidence: 99%

“…Experiments with ultraviolet light have demonstrated the induction of stable chlorpromazine-ssDNA complexes [60]. Reports of Coombs-positive studies, false-positive syphilis tests, and thrombocytopenia have been made, but are few in number [14,39,41,43,47,48].…”

Section: Phenothiazinesmentioning

confidence: 99%

Drug-Induced Lupus Anticoagulants and Antiphospholipid Antibodies

Dlott

Roubey

2011

Curr Rheumatol Rep

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Lupus anticoagulants (LA) are immunoglobulins (IgG, IgM, and/or IgA) which interfere with one or more of phospholipid-dependent in vitro coagulation tests, eg, activated partial thromboplastin time (aPTT), kaolin clotting time (KCT), dilute Russell viper venom time (dRVVT), and dilute prothrombin time (dPT). LAs may be seen in a variety of clinical settings including the primary antiphospholipid syndrome (APS), systemic lupus erythematosus (SLE), other autoimmune diseases, secondary to infections, malignancies, and in association with certain drugs. LAs associated with the antiphospholipid syndrome and other autoimmune disease recognize certain phospholipid-binding proteins (β(2)-glycoprotein I [β(2)GPI] or prothrombin). Many drugs have been implicated as possibly causing LAs, although the majority of such cases are limited to a select few. Drug-induced LAs are heterogeneous, differing in laboratory findings as well as related clinical complications. This paper reviews the English medical literature on drug-induced LA and potential mechanisms of induction.

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“…This increase contrasts with the in vitro anticoagulant effects of these autoantibodies. Anticardiolipin antibody levels have frequently been reported to be elevated in patients taking conventional antipsychotics (Canoso and de Oliveira, 1988; el-Mallakh et al, 1988; Canoso et al, 1990; Metzer et al, 1994; Schwartz et al, 1998; Steen and Ramsey-Goldman, 1988) and clozapine (Davis et al, 1994). Venous thrombosis appears to be associated with the use of antipsychotic drugs in psychiatric patients (Thomassen et al, 2001).…”

Section: Thrombogenic Substances Acting On the Coagulative Systemmentioning

confidence: 99%

Drug-Induced Thrombosis—Experimental, Clinical, and Mechanistic Considerations

Ramot

Nyska²

2007

Toxicol Pathol

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Awareness of the dangers of drug-induced thrombosis has recently been heightened and led to demand for improved testing methodology. For example, reports indicating that some selective inhibitors of cyclooxygenase-2 (COX-2) increase the risk of myocardial infarction and atherothrombotic events caused the withdrawal of rofecoxib from global markets and the issuance of warnings concerning the usage of other COX-2 inhibitors. Drugs may exert a prothrombotic state by a variety of mechanisms-those affecting the vessel wall, the blood flow, and/or different blood constituents. Our review serves as an update to that of Gerhard Zbinden published in 1976 by presenting recently acquired data that more fully elucidate the different mechanisms by which drugs are believed to induce thrombogenic effects and discussing new methods used to detect these without losing sight of the classical pathology of thrombosis. We offer correlations between experimental findings and clinical data and conclude that, because drugs may induce a prothrombotic state by a variety of mechanisms, they should be tested for these using appropriate experimental methods and animal models.

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Phenothiazine-Associated Lupus Anticoagulant and Thrombotic Disease

Cited by 12 publications

References 23 publications

Risk of venous thromboembolism due to antipsychotic drug therapy

Risk of venous thromboembolism due to antipsychotic drug therapy

Drug-Induced Lupus Anticoagulants and Antiphospholipid Antibodies

Drug-Induced Thrombosis—Experimental, Clinical, and Mechanistic Considerations

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