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Thromb Haemost 2016; 115(06): 1209-1219
DOI: 10.1160/TH15-11-0895
Stroke, Systemic or Venous Thromboembolism
Schattauer GmbH

Use of antipsychotics and risk of venous thromboembolism in postmenopausal women

A population-based nested case-control study
Meng-Ting Wang
1   School of Pharmacy, National Defense Medical Center, Taipei, Taiwan, Republic of China
,
Jun-Ting Liou
2   Division of Cardiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China
,
Yun-Wen Huang
1   School of Pharmacy, National Defense Medical Center, Taipei, Taiwan, Republic of China
,
Chen Wei Lin
1   School of Pharmacy, National Defense Medical Center, Taipei, Taiwan, Republic of China
,
Gwo-Jang Wu
3   Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan, Republic of China
4   Department of Obstertrics and Gynecology, Reproductive Medical Center, Tri-Service General Hospital, Taipei, Taiwan, Republic of China
,
Che-Li Chu
1   School of Pharmacy, National Defense Medical Center, Taipei, Taiwan, Republic of China
,
Chin-Bin Yeh
5   Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China
,
Yun-Han Wang
1   School of Pharmacy, National Defense Medical Center, Taipei, Taiwan, Republic of China
› Author Affiliations Financial support: This study was supported by the National Science Council (NSC102–2320-B016–005).
Further Information

Publication History

Received: 21 November 2015

Accepted after major revision: 20 February 2016

Publication Date:
27 November 2017 (online)

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Summary

Despite continued uncertainty of venous thromboembolism (VTE) caused from antipsychotic agents, this safety issue has not been examined in postmenopausal women, a population with high usages of antipsychotics and at high risk for VTE. We assessed whether antipsychotic use was associated with an increased VTE risk in women after menopause. We conducted a nested case-control study of all Taiwanese women aged ≥ 50 years (n = 316,132) using a nationwide healthcare claims database between 2000 and 2011. All newly diagnosed VTE patients treated with an anticoagulant or thrombectomy surgery were identified as cases (n = 2,520) and individually matched to select controls (n = 24,223) by cohort entry date, age, cancer diagnosis and major surgery procedure. The odds ratios (ORs) and 95 % confidence interval (CI) of VTE associated with antipsychotics were estimated by multivariate conditional logistic regressions. Current use of antipsychotics was associated with a 1.90-fold (95 % CI = 1.64–2.19) increased VTE risk compared with nonuse in postmenopausal women. The VTE risk existed in a dose-dependent fashion (test for trend, p<0.001), with a more than quadrupled risk for high-dose antipsychotics (adjusted OR = 4.60; 95 % CI = 2.88–7.33). Current parenteral administration of antipsychotics also led to a 3.46-fold increased risk (95 % CI = 2.39–5.00). Conversely, there was no increased VTE risk when antipsychotics were discontinued for > 30 days. In conclusion, current use of antipsychotics is significantly associated with a dose-dependent increased risk of VTE in postmenopausal women, especially for those currently taking high-dose or receiving parenteral antipsychotics.

Keywords

Venous thromboembolism (VTE) - nested case-control - antipsychotics - postmenopause - epidemiology

 

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