Massive pulmonary thromboembolism demonstrated at necropsy in Japanese psychiatric patients treated with neuroleptics including atypical antipsychotics.
BACKGROUND
There may be an increased risk of pulmonary thromboembolism (PTE) with antipsychotic drugs, so this association was investigated in autopsy cases of sudden unexpected death determined by the Department of Legal Medicine of a Japanese university hospital.


RESULTS
Records of 1,125 forensic autopsies (808 males, 317 females) performed during the study period for investigation of the cause of sudden unexpected death were reviewed and a logistic regression analysis was performed to explore whether age, gender, body mass index (BMI), and antipsychotic drug use were associated with fatal PTE. Among all records, 34 (3.0%; 14 males, 20 females) indicated the use of antipsychotic drugs and 28 (2.5%; 9 males, 19 females) indicated PTE as the cause of death. Of the 28 subjects who died from PTE, 8 had taken antipsychotic drugs (29%) and all were female. Female gender and antipsychotic drug use accounted for a significantly higher risk of PTE death with an odds ratio of 4.22 (95% confidence interval (CI), 1.82-9.78; p<0.01) and 10.49 (95% CI, 3.95-27.85; p<0.01), respectively.


CONCLUSIONS
Japanese women taking antipsychotic drugs may be at particular risk for PTE.
Department of Psychiatry, School of Medicine, Kitasato University, Sagamihara, Japan. lesalondusatoko@aol.com
Satoko
S
Hamanaka
Yoshito
Y
Kamijo
Tomonori
T
Nagai
Katsuyoshi
K
Kurihara
Katsutoshi
K
Tanaka
Kazui
K
Soma
Hitoshi
H
Miyaoka
D000368:Aged; D018687:Antidepressive Agents, Second-Generation / Q000009:adverse effects*; D014150:Antipsychotic Agents / Q000009:adverse effects*; D001344:Autopsy; D003645:Death, Sudden; D005260:Female; D006801:Humans; D007564:Japan; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D011618:Psychotic Disorders / Q000188:drug therapy*; D011655:Pulmonary Embolism / Q000139:chemically induced* / Q000401:mortality
D018687:Antidepressive Agents, Second-Generation; D014150:Antipsychotic Agents