Conti Valentino, Venegoni Mauro, Cocci Alfredo, Fortino Ida, Lora Antonio, Barbui Corrado
Regional Centre for Pharmacovigilance, Lombardy Region, Milano, Italy.
Unit of Community Health Services, Regional Health Ministry, Lombardy Region, Milan, Italy.
BMC Psychiatry. 2015 Apr 29;15:92. doi: 10.1186/s12888-015-0479-9.
Only three observational studies investigated whether exposure to antipsychotics is associated with an increased risk of pulmonary embolism, with conflicting results. This study was therefore carried out to establish the risk of pulmonary embolism associated with antipsychotic drugs, and to ascertain the risk associated with first- and second-generation antipsychotic drugs, and with exposure to individual drugs.
We identified 84,253 adult individuals who began antipsychotic treatment in a large Italian health care system. Cases were all cohort members who were hospitalized for non-fatal or fatal pulmonary embolism during follow-up. Up to 20 controls for each case were extracted from the study cohort using incidence density sampling and matched by age at cohort entry and gender. Each individual was classified as current, recent or past antipsychotic user. The occurrence non-fatal or fatal pulmonary embolism was the outcome of interest.
Compared to past use, current antipsychotic use more than double the risk of pulmonary embolism (odds ratio 2.31, 95% confidence interval 1.16 to 4.59), while recent use did not increase the risk. Both conventional and atypical antipsychotic exposure was associated with an increase in risk, and the concomitant use of both classes increased the risk of four times (odds ratio 4.21, 95% confidence interval 1.53 to 11.59).
Adding the results of this case-control study to a recent meta-analysis of three observational studies substantially changed the overall estimate, which now indicates that antipsychotic exposure significantly increases the risk of pulmonary embolism.
仅有三项观察性研究探讨了使用抗精神病药物是否会增加肺栓塞风险，结果相互矛盾。因此开展本研究以确定与抗精神病药物相关的肺栓塞风险，并确定与第一代和第二代抗精神病药物以及与使用个别药物相关的风险。
我们在一个大型意大利医疗保健系统中识别出84253名开始接受抗精神病治疗的成年个体。病例为随访期间因非致命性或致命性肺栓塞住院的所有队列成员。采用发病密度抽样从研究队列中为每个病例抽取多达20名对照，并按队列进入时的年龄和性别进行匹配。每个个体被分类为当前、近期或既往抗精神病药物使用者。非致命性或致命性肺栓塞的发生是感兴趣的结局。
与既往使用相比，当前使用抗精神病药物使肺栓塞风险增加一倍以上（比值比2.31，95%置信区间1.16至4.59），而近期使用未增加风险。使用传统和非典型抗精神病药物均与风险增加相关，两类药物同时使用使风险增加四倍（比值比4.21，95%置信区间1.53至11.59）。
将本病例对照研究的结果加入到近期对三项观察性研究的荟萃分析中，显著改变了总体估计，现在表明使用抗精神病药物会显著增加肺栓塞风险。
