Vu Vu Hoang, Khang Nguyen Duong, Thao Mai Thanh, Khoi Le Minh
Cardiovascular Center, University Medical Center, University of Medicine and Pharmacy at Ho Chi Minh City, Vietnam.
Department of Radiology, University Medical Center, Ho Chi Minh City, Vietnam.
Case Rep Vasc Med. 2021 Jul 27;2021:5138509. doi: 10.1155/2021/5138509. eCollection 2021.
Olanzapine is a second-generation antipsychotic drug commonly prescribed for certain mental/mood conditions such as schizophrenia and bipolar disorders. This agent has been considered a precipitating factor for venous thromboembolism formation. Most of the cases previously reported were associated with high-dose olanzapine therapy or in patients with high-risk factors for the development of thromboembolism. . We report a patient who developed pulmonary embolism after a long course of low-dose olanzapine. A 66-year-old female patient suffering from insomnia had been prescribed olanzapine 2.5 mg and paroxetine 10 mg for two years. The patient suddenly developed a syncopal episode at home and was immediately brought to the hospital. The diagnosis of pulmonary embolism was made by chance during the computerized tomography of coronary arteries. The patient made a full recovery under conventional treatment and was discharged in stable condition. The thoracic computed tomography taken two months after discharge showed a completely normal pulmonary arterial tree.
Olanzapine-associated pulmonary embolism is a rare entity and might be missed if the physician in charge is not vigilant and well informed. Even low-dose olanzapine can be associated with pulmonary embolism in patients with low classic risk factors if the treatment is prolonged. Pulmonary embolism should be sought in patients taking olanzapine even though the presenting manifestations are nonspecific.
奥氮平是一种第二代抗精神病药物，常用于治疗某些精神/情绪疾病，如精神分裂症和双相情感障碍。该药物被认为是静脉血栓栓塞形成的一个促发因素。先前报道的大多数病例与高剂量奥氮平治疗有关，或发生在有血栓栓塞发生高危因素的患者中。我们报告一例在长期服用低剂量奥氮平后发生肺栓塞的患者。一名66岁患有失眠症的女性患者服用奥氮平2.5毫克和帕罗西汀10毫克已有两年。患者在家中突然发生晕厥，随后立即被送往医院。在冠状动脉计算机断层扫描过程中偶然诊断出肺栓塞。患者在接受常规治疗后完全康复，出院时病情稳定。出院两个月后进行的胸部计算机断层扫描显示肺动脉树完全正常。
奥氮平相关的肺栓塞是一种罕见情况，如果主管医生不警惕且了解不足，可能会漏诊。如果治疗时间延长，即使是低剂量奥氮平也可能与低经典风险因素患者的肺栓塞有关。即使临床表现不具特异性，服用奥氮平的患者也应排查肺栓塞。
