clozapine and Venous-Thrombosis

Topics: Adult; Antipsychotic Agents; Brain; Clozapine; Female; Humans; Intracranial Thrombosis; Magnetic Resonance Imaging; Schizophrenia; Tomography, X-Ray Computed; Venous Thrombosis

Clozapine treatment for resistant schizophrenic disorders has been associated to venous thromboembolic events. We report the case of a patient who developed upper-extremity deep vein thrombosis just 2 months after starting on clozapine in whom the thrombophilia work-up revealed the presence of the prothrombin G20210A mutation.

Topics: Clozapine; Humans; Male; Middle Aged; Point Mutation; Prothrombin; Thrombophilia; Upper Extremity; Venous Thrombosis

1. Several studies suggest an association between venous thromboembolism and the use of antipsychotic drugs, especially clozapine, but the biological mechanisms are unknown. It has been suggested that antipsychotic drugs enhance aggregation of platelets and thereby increase the risk of venous thrombosis. The purpose of the present study was to examine the effects of clozapine and its main metabolite, N-desmethyl clozapine, as well as olanzapine, risperidone and haloperidol, on platelet adhesion and aggregation and on plasma coagulation in vitro. 2. Blood was collected from healthy subjects free of medication. Platelet adhesion to different protein surfaces and aggregation were measured in microplates. The coagulation methods of activated partial thromboplastin time (APTT) and prothrombin time were performed in platelet-poor plasma. 3. Clozapine was the only compound that increased platelet adhesion and aggregation and shortened APTT. The effect appeared at therapeutic concentrations and was significant but weak. 4. This weak effect of clozapine on haemostasis may explain, in part, the association of this compound and venous thromboembolism.

Topics: Adult; Aged; Antipsychotic Agents; Benzodiazepines; Blood Coagulation; Blood Platelets; Clozapine; Dose-Response Relationship, Drug; Female; Haloperidol; Humans; In Vitro Techniques; Male; Middle Aged; Olanzapine; Partial Thromboplastin Time; Platelet Adhesiveness; Platelet Aggregation; Prothrombin Time; Risperidone; Thromboembolism; Venous Thrombosis

Lipomas usually extend in subcutaneous tissues and rarely may be compressive. We report a case of neck lipoma resulting in jugular vein thrombosis and pulmonary embolism in a patient treated by clozapine. Clozpine may be considered an associated risk factor for thrombosis. This case suggests that performing a regional evaluation may be particularly important when thrombophlebitis occurs.

Topics: Antipsychotic Agents; Clozapine; Head and Neck Neoplasms; Humans; Jugular Veins; Lipoma; Male; Middle Aged; Pulmonary Embolism; Radiography; Risk Factors; Venous Thrombosis

To describe the occurrence of pulmonary embolism (PE) as a rare adverse effect of clozapine that is treatable, but sometimes fatal, and survey the literature on the subject in the hope of increasing awareness of the potential danger that may result from drug interactions.. A 47-year-old woman treated with clozapine and paroxetine was admitted to the hospital with dyspnea and swelling of the leg. The patient was diagnosed as having PE and was treated with intravenous heparin. On hospital day 7, sudden acute respiratory failure developed and the patient died. Postmortem examination confirmed the existence of massive PE.. The woman had no identifiable risk factors other than receiving a combination of clozapine and paroxetine, with a demonstrated elevated clozapine blood concentration. Use of the Naranjo probability scale revealed a probable likelihood that the adverse reaction was drug related.. The association of antipsychotic drugs and venous thromboembolism has been previously described, but is still a rare finding. This case highlights the importance of monitoring and possibly discontinuing treatment when venous thrombosis is suspected. There should be careful monitoring, especially in patients with risk factors for thrombosis. Finally, antidepressant-antipsychotic drug combinations can increase the risk of rare adverse effects, such as venous thromboembolism, even in the absence of other risk factors.

Topics: Antidepressive Agents, Second-Generation; Antipsychotic Agents; Blood Coagulation; Clozapine; Drug Interactions; Fatal Outcome; Female; Humans; Middle Aged; Paroxetine; Pulmonary Embolism; Venous Thrombosis

Topics: Adult; Antipsychotic Agents; Clozapine; Humans; Male; Pulmonary Embolism; Schizophrenia; Thromboembolism; Venous Thrombosis

To examine the association between the use of psychotropic drugs and fatal pulmonary embolism.. We conducted a national case-control study of fatal pulmonary embolism. Cases were 75 New Zealand men and women aged 15-59 years who died between 1 January 1990 and 31 December 1998, where the underlying cause of death was certified as codes 415.1, 451 or 453 of the International Classification of Diseases (9th Revision). Four controls, matched for sex and age, were selected from the general practice to which each case had belonged. Information was abstracted from the records of general practitioners, family planning clinics and psychiatric services. Odds ratios and 95% confidence intervals (95% CI) were estimated using conditional logistic regression. The key analyses were restricted to cases (n = 62) and controls (n = 243) without major risk factors for venous thromboembolism.. Compared to non-use, the adjusted odds ratio for current use of antipsychotic drugs was 13.3 (95% CI: 2.3-76.3). Low potency antipsychotics appeared to carry the highest risk (odds ratio: 20.8 [95% CI: 1.7-259.0]). The main drug involved was thioridazine. The odds ratio for current use of antidepressants was also increased, at 4.9 (95% CI: 1.1-22.5).. Our results for conventional antipsychotics are consistent with previous studies of non-fatal venous thromboembolism. The finding for antidepressants needs to be replicated in other studies.

Topics: Adolescent; Adult; Antipsychotic Agents; Case-Control Studies; Clozapine; Female; Humans; Male; Middle Aged; New Zealand; Psychotropic Drugs; Pulmonary Embolism; Risk Factors; Venous Thrombosis

Topics: Adverse Drug Reaction Reporting Systems; Antipsychotic Agents; Clozapine; Humans; Pulmonary Embolism; Thromboembolism; United States; Venous Thrombosis

Data from the Swedish Adverse Reactions Advisory Committee suggest that use of clozapine is associated with venous thromboembolic complications. We summarise 12 cases of thromboembolism during clozapine treatment. In five cases the outcome was fatal.

Topics: Adult; Adverse Drug Reaction Reporting Systems; Antipsychotic Agents; Clozapine; Female; Humans; Male; Middle Aged; Pulmonary Embolism; Sweden; Venous Thrombosis

Topics: Adrenergic Uptake Inhibitors; Amitriptyline; Antidepressive Agents, Tricyclic; Antipsychotic Agents; Chlorpromazine; Clozapine; Humans; Imipramine; Incidence; Thromboembolism; Venous Thrombosis

Topics: Adverse Drug Reaction Reporting Systems; Antipsychotic Agents; Clozapine; Drug Monitoring; Humans; Risk Factors; Thromboembolism; Venous Thrombosis

Topics: Adolescent; Adult; Adverse Drug Reaction Reporting Systems; Aged; Antipsychotic Agents; Clozapine; Female; Humans; Male; Middle Aged; Pulmonary Embolism; Risk Factors; Schizophrenia; Thromboembolism; United States; United States Food and Drug Administration; Venous Thrombosis