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Antipsychotic medication and venous thrombosis

Department of Psychiatry, Leiden University Medical Center, The Netherlands

JAN P. VANDENBROUCKE, PhD

Department of Clinical Epidemiology, Leiden University Medical Center, The Netherlands

FRITS R. ROSENDAAL, MD

Department of Clinical Epidemiology and Thrombosis and Haemostasis Center, Leiden University Medical Center, The Netherlands

Correspondence: Jan P. Vandenbroucke, Leiden University Medical Center, Department of Clinical Epidemiology, PO Box 9600, 2300 RC Leiden, The Netherlands. Tel.: +31 71 5265230; Fax: +3171 5248122; e-mail: vdbroucke{at}mail.medfac.leidenuniv.nl

Declaration of interest None.

Background In an autopsy series, 10 out of 27 deaths in which ‘idiopathic’ pulmonary emboli were discerned as the sole cause of death had occurred in psychiatric patients.

Aims To investigate whether antipsychotic medication is a risk factor for venous thrombosis.

Method A description of the 10 psychiatric patients was obtained from the pulmonary emboli autopsy reports. We carried out a brief historic overview of the literature. We re-analysed data from the Leiden Thrombophilia Study (LETS), a case—control study on patients with venous thrombosis.

Results In the autopsy reports, five out of 10 psychiatric patients with fatal pulmonary embolism had confirmed use of antipsychotic drugs. After the application of chlorpromazine and its analogues a higher incidence of venous thrombosis in psychiatric patients was described in the German literature between 1953 and 1977. In the re-analysis of the LETS case—control study, four patients used antipsychotic drugs versus none in the control group. Recent epidemiological studies of good methodological quality have confirmed these findings.

Conclusions Venous thrombosis appears to be associated with the use of antipsychotic drugs in psychiatric patients.

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