title: Use of antipsychotics and risk of venous thromboembolism in postmenopausal women. A population-based nested case-control study.
abstract: Despite continued uncertainty of venous thromboembolism (VTE) caused from antipsychotic agents, this safety issue has not been examined in postmenopausal women, a population with high usages of antipsychotics and at high risk for VTE. We assessed whether antipsychotic use was associated with an increased VTE risk in women after menopause. We conducted a nested case-control study of all Taiwanese women aged ≥ 50 years (n = 316,132) using a nationwide healthcare claims database between 2000 and 2011. All newly diagnosed VTE patients treated with an anticoagulant or thrombectomy surgery were identified as cases (n = 2,520) and individually matched to select controls (n = 24,223) by cohort entry date, age, cancer diagnosis and major surgery procedure. The odds ratios (ORs) and 95 % confidence interval (CI) of VTE associated with antipsychotics were estimated by multivariate conditional logistic regressions. Current use of antipsychotics was associated with a 1.90-fold (95 % CI = 1.64-2.19) increased VTE risk compared with nonuse in postmenopausal women. The VTE risk existed in a dose-dependent fashion (test for trend, p<0.001), with a more than quadrupled risk for high-dose antipsychotics (adjusted OR = 4.60; 95 % CI = 2.88-7.33). Current parenteral administration of antipsychotics also led to a 3.46-fold increased risk (95 % CI = 2.39-5.00). Conversely, there was no increased VTE risk when antipsychotics were discontinued for > 30 days. In conclusion, current use of antipsychotics is significantly associated with a dose-dependent increased risk of VTE in postmenopausal women, especially for those currently taking high-dose or receiving parenteral antipsychotics.
authors.affiliation: Meng-Ting Wang, PhD, School of Pharmacy, National Defense Medical Center, 9 F, No.161, Section 6, Min-Chuan East Road, Taipei 114, Taiwan, Tel.: +886 2 8792 3100 ext. 18870, Fax: +886 2 8792 3169, E-mail: wmt@mail.ndmctsgh.edu.tw.
authors.forename: Meng-Ting
authors.initials: MT
authors.lastname: Wang
authors.forename: Jun-Ting
authors.initials: JT
authors.lastname: Liou
authors.forename: Yun-Wen
authors.initials: YW
authors.lastname: Huang
authors.forename: Chen Wei
authors.initials: CW
authors.lastname: Lin
authors.forename: Gwo-Jang
authors.initials: GJ
authors.lastname: Wu
authors.forename: Che-Li
authors.initials: CL
authors.lastname: Chu
authors.forename: Chin-Bin
authors.initials: CB
authors.lastname: Yeh
authors.forename: Yun-Han
authors.initials: YH
authors.lastname: Wang
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D014150:Antipsychotic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D016022:Case-Control Studies; D015331:Cohort Studies; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D017698:Postmenopause; D012307:Risk Factors; D013624:Taiwan / Q000453:epidemiology; D054556:Venous Thromboembolism / Q000139:chemically induced* / Q000453:epidemiology / Q000209:etiology
chemical_list: D014150:Antipsychotic Agents
keywords: Venous thromboembolism (VTE); antipsychotics; epidemiology; nested case-control; postmenopause