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The British Journal of Psychiatry (2002) 180: 85
© 2002 The Royal College of Psychiatrists

Correspondence

Antipsychotics and risk of venous thrombosis

F. Curtin and M. Blum

Intercantonal Office for the Control of Medicines, Erlachstrasse 8, 3000 Bern 9, Switzerland

EDITED BY MATTHEW HOTOPF

The article by Thomassen et al (2001) relates a higher risk of venous thrombosis to the use of antipsychotic drugs. As mentioned by the authors, their data cannot consequentially link the risk of venous thrombosis to antipsychotic use as certain biases cannot be excluded from the autopsy date and case—control studies they analyse. However, their study adds to the numerous reports suggesting a link between this class of medication and venous thrombosis. In this debate, however, it should be noted that there is a lack of controlling for factors such as the dose of antipsychotics and the type of psychosis. Catatonia is typically a form of schizophrenia in which one could expect patients to have a higher risk of venous thrombosis (Morioka et al, 1997). Similarly, according to the dose of antipsychotic, the sedation of patients can be so intense that their movements are limited, creating predisposing conditions for venous thrombosis. It is possible that more cautious administration of antipsychotics at a dose which decreases the psychotic symptoms without inducing toxic sedation (Casey, 1997) could prevent a certain number of thrombosis cases, although low doses of antipsychotic appeared paradoxically associated with higher risk in a recent case—control study (Zornberg & Jick, 2000). Exploring the role of these potential confounding factors, particularly in cohort studies, is important to characterise the safety profile of antipsychotic drugs and to improve guidelines for the treatment of patients with psychosis.

REFERENCES

  1. Casey, D. E. (1997) The relationship of pharmacology to side effects. Journal of Clinical Psychiatry, 58, 55-62.
  2. Morioka, H., Nagatomo, I., Yamada, K., et al (1997) Deep venous thrombosis of the leg due to psychiatric stupor. Psychiatry and Clinical Neurosciences, 51, 323-326.[Medline]
  3. Thomassen, R., Vandenbroucke, J. P. & Rosendaal, F. R. (2001) Antipsychotic medication and venous thrombosis. British Journal of Psychiatry, 179, 63-66.[Abstract/Free Full Text]
  4. Zornberg, G. L. & Jick, H. (2000) Antipsychotic drug use and the risk of first-time idiopathic venous thromboembolism. A case—control study. Lancet, 356, 1219-1223.[CrossRef][Medline]



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