Department of Pharmacy, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Health Outcome Research Center, National Cheng Kung University, Tainan, Taiwan.
Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan; School of Pharmacy, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Health Outcome Research Center, National Cheng Kung University, Tainan, Taiwan.
J Psychiatr Res. 2021 Jul;139:159-166. doi: 10.1016/j.jpsychires.2021.05.025. Epub 2021 May 23.
Antipsychotics remain the first choice of treatment for post-stroke psychosis, despite an increased risk of mortality reported in elderly patients. We aimed to compare the mortality risk among antipsychotics in elderly patients with stroke using the stroke registry for external adjustment.
We conducted a retrospective cohort study to identify patients aged above 65 years who were admitted for stroke in the National Health Insurance Database (NHID) from 2002 to 2014. The first date of antipsychotic use after the stroke hospitalization was defined as the index date. Covariates including diseases, medications and external information on smoking, BMI, stroke severity and disability, that were unavailable in the NHID were obtained from the linked Multicenter Stroke Registry (MSR) and used for propensity score calibration (PSC). The main outcome was one-year all-cause mortality.
Stroke patients in the NHID prescribed with haloperidol, quetiapine and risperidone numbered 22,235, 28,702 and 8 663, respectively. In the PSC-adjusted analyses, haloperidol [adjusted hazard ratio (aHR) = 1.22; 95% CI 1.18-1.27] and risperidone (aHR = 1.31; 95% CI 1.24-1.38) users had a higher mortality risk than quetiapine users. When the dosage was higher than 0.5 defined daily dose (DDD), haloperidol and risperidone users had a significant mortality risk as compared with those taking a lower dose.
In post-stroke elderly patients, quetiapine would pose less mortality risk than risperidone and haloperidol at doses higher than 0.5 DDD. When haloperidol or risperidone is indicated, starting with a lower dose is suggested to avoid excess risk.
尽管有报道称老年患者的死亡率增加，但抗精神病药仍然是中风后精神病的首选治疗方法。我们旨在使用中风登记处进行外部调整，比较老年中风患者使用抗精神病药的死亡率风险。
我们进行了一项回顾性队列研究，以确定 2002 年至 2014 年期间在国家健康保险数据库（NHID）中因中风住院的年龄在 65 岁以上的患者。中风住院后首次使用抗精神病药的日期定义为索引日期。从链接的多中心中风登记处（MSR）获得了 NHID 中无法获得的疾病、药物以及有关吸烟、BMI、中风严重程度和残疾的外部信息，并用于倾向评分校准（PSC）。主要结局为一年全因死亡率。
NHID 中被处方氟哌啶醇、喹硫平、利培酮的中风患者人数分别为 22235、28702 和 8663。在 PSC 调整分析中，氟哌啶醇（调整后的危险比[aHR]1.22；95%CI 1.18-1.27）和利培酮（aHR 1.31；95%CI 1.24-1.38）使用者的死亡率风险高于喹硫平使用者。当剂量高于 0.5 定义日剂量（DDD）时，氟哌啶醇和利培酮使用者的死亡率风险显著高于使用较低剂量的使用者。
在中风后老年患者中，与利培酮和氟哌啶醇相比，剂量高于 0.5 DDD 时，喹硫平的死亡率风险较低。当需要使用氟哌啶醇或利培酮时，建议起始剂量较低以避免风险过高。
