olanzapine and Venous-Thromboembolism

The association between antipsychotic medication and increased risk for deep vein thrombosis and pulmonary embolism has been reported since soon after the introduction of first-generation antipsychotic drugs in the 1950s. The causality of this association, its risk factors, and its implications for clinical practice have not been fully elucidated. We undertook a systematic literature review to evaluate the evidence for an association between antipsychotic medication and venous thromboembolic events and to identify risk factors for these adverse effects.. MEDLINE search for the 1990-2012 interval, followed by a manual review of identified publication for relevant cohort and case studies involving antipsychotic medication and thromboembolic events. Data regarding antipsychotic-related thromboembolic events have been presented in five autopsy series, three cohort studies, eight case-control and nine case series, and 13 individual case reports. Nine studies provided odds-ratios for thrombotic risk for all antipsychotic medications. There was substantial evidence-based agreement that antipsychotic drugs increase the risk of venous thromboembolic events. The average reported odds ratio was 3.51, compared with patients not receiving these drugs. The database identified a total of 438 reported of venous thromboembolic events with clozapine, nearly double the next most commonly reported medications risperidone (283) and olanzapine (241). The factors that increased risk were use of second-generation antipsychotics, low potency antipsychotics, antipsychotic polytherapy. Data also suggested a dose-dependent increase in the risk of thrombotic complications.. The risk factors for antipsychotic-related thrombolembolic events include recently started antipsychotic therapy (within the past 3 or 12 months), higher doses of drug, concomitant multiple antipsychotic therapy, intravenous or intramuscular administration of drug, and use of second-generation antipsychotics, particularly clozapine.

Topics: Antipsychotic Agents; Benzodiazepines; Clozapine; Humans; Odds Ratio; Olanzapine; Risk Factors; Risperidone; Thrombosis; Venous Thromboembolism

Psychiatric disorders and treatment with conventional antipsychotic medications have been associated with venous thromboembolism, but only a few data on recent antipsychotics such as olanzapine are available.. We describe four subjects treated with olanzapine who developed venous thromboembolism, and were hospitalized at the University Hospital in Hradec Kralove during the period 2004-2006.. We found a combination of several clinical and laboratory risk factors in our patients.. A cohort study or case-control studies are needed to better elucidate the possible role of olanzapine in etiopathogenesis of venous thromboembolism.

Topics: Adult; Antipsychotic Agents; Benzodiazepines; Body Mass Index; Female; Humans; Male; Middle Aged; Olanzapine; Risk Factors; Schizophrenia; Schizophrenia, Paranoid; Ultrasonography; Venous Thromboembolism

Topics: Aged; Antipsychotic Agents; Benzodiazepines; Fatal Outcome; Female; Haloperidol; Heart Arrest; Heart Failure; Humans; Hypnotics and Sedatives; Lorazepam; Olanzapine; Practice Guidelines as Topic; Pulmonary Artery; Pulmonary Embolism; Restraint, Physical; Schizophrenia, Paranoid; Venous Thromboembolism

Concern has been raised about the occurrence of venous thromboembolism (VTE) during treatment with antipsychotics. However, to date, clozapine is the only antipsychotic agent for which recurring evidence supports an association with VTE. Therefore, the aim of this study was to investigate the association between antipsychotic drugs, including clozapine and VTE.. Data mining of the WHO database of adverse drug reactions (ADRs) using Bayesian statistics is in routine use for early alerting to possible ADRs. An information component measure was used to investigate the association between antipsychotic drugs and VTE reactions in the database.. A total of 754 suspected cases of VTE related to treatment with antipsychotics had been reported. After excluding cases related to clozapine, 379 cases remained. A robust association was found for the second-generation antipsychotics group but not for the high-potency, first-generation antipsychotics group or the low-potency first-generation antipsychotics group. The individual compounds with statistically significant associations were olanzapine, sertindole and zuclopenthixol. A time-dependent analysis showed that the associations were positive for these drugs in 2002, 2001 and 2003, respectively. Case analyses were undertaken after excluding ten suspected duplicate reports. Of the remaining 369 cases, 91 cases were associated with olanzapine, 9 with zuclopenthixol and 6 with sertindole.. VTE was more often reported with the antipsychotic drugs olanzapine, sertindole and zuclopenthixol than with other drugs in the WHO database. Further studies are warranted to explain this disproportional reporting. Since the associations found were based on incomplete clinical data, the results should be considered as preliminary and interpreted cautiously.

Topics: Adult; Adverse Drug Reaction Reporting Systems; Antipsychotic Agents; Bayes Theorem; Benzodiazepines; Clopenthixol; Databases, Factual; Female; Humans; Imidazoles; Indoles; Male; Middle Aged; Olanzapine; Time Factors; Venous Thromboembolism; World Health Organization; Young Adult