Borras Laurence, Eytan Ariel, de Timary Philippe, Constant Eric-Louis, Huguelet Philippe, Hermans Cédric
Department of Psychiatry, Division of Adult Psychiatry, University Hospitals of Geneva, Geneva, Switzerland.
J Emerg Med. 2008 Aug;35(2):159-61. doi: 10.1016/j.jemermed.2007.07.074. Epub 2008 Feb 20.
Several studies and reports suggest an increased risk of venous thromboembolism (VTE) in patients treated with conventional antipsychotic drugs, as well as with clozapine. We report the case of a 25-year-old man with early-onset schizo-affective disorder, with no identified risk factor for thromboembolism, who developed pulmonary embolism on three occasions, once shortly after initiating treatment with olanzapine and twice with risperidone. This case indicates that VTE can be associated with the use of olanzapine and risperidone, two atypical agents having similar properties and the same 5HT2 receptors antagonism, possibly implicated in this adverse event. As suggested by this observation, patients who have had one episode of VTE with antipsychotics with an affinity for 5HT2 receptors should receive neuroleptics from other classes, such as amisulpride, which does not interact with 5HT2 receptors. They should also be closely monitored to ensure early detection and prompt treatment of VTE.
多项研究和报告表明，使用传统抗精神病药物以及氯氮平治疗的患者发生静脉血栓栓塞（VTE）的风险增加。我们报告了一例25岁早发性精神分裂症伴情感障碍男性患者的病例，该患者无已确定的血栓栓塞危险因素，却三次发生肺栓塞，一次是在开始使用奥氮平治疗后不久，另外两次是在使用利培酮治疗期间。该病例表明，VTE可能与使用奥氮平和利培酮有关，这两种非典型药物具有相似特性且对5HT2受体有相同的拮抗作用，可能与这一不良事件有关。正如该观察结果所提示的，曾因对5HT2受体有亲和力的抗精神病药物发生过一次VTE的患者，应使用其他类型的抗精神病药物，如不与5HT2受体相互作用的氨磺必利。还应对这些患者进行密切监测，以确保早期发现并及时治疗VTE。
