Antipsychotic and Antidepressant Drug Use in the Elderly and the Risk of Venous Thromboembolism

Summary

Background

Preliminary evidence suggests that use of antipsychotic drugs is associated with an increased risk of venous thromboembolism.

Objective

To evaluate the relationship between antipsychotic or antidepressant drug use and venous thromboembolism among adults aged 65 years and older.

Design

Retrospective cohort study using linked health care administrative databases over a nine year period.

Setting

The entire province of Ontario, Canada.

Participants

Individuals aged 65 years and over exclusively prescribed either antipsychotic drugs (n = 22514), antidepressant drugs (n = 75649) or thyroid replacement hormones (33033), the referent control group. We excluded those with an antecedent history of cardiovascular disease, venous thromboembolism or cancer, as well as those dispensed warfarin before study entry.

Measurements

Diagnosis of deep vein thrombosis or pulmonary embolism.

Results

Relative to those prescribed thyroid hormones, neither anti-depressant (adjusted hazard ratio 1.02, 95% CI 0.91-1.14) nor anti-psychotic (adjusted hazard ratio 1.13, 95% CI 0.96-1.32) drug use was associated with an increased risk for deep vein thrombosis. Similar risk estimates were found for deep vein thrombosis or pulmonary embolism. In a sub-group analysis, only butyrophenone use was found to be associated with a slightly increased risk of deep vein thrombosis (adjusted HR 1.51, 95% CI 1.23-1.86) as well as deep vein thrombosis or pulmonary embolism (adjusted HR 1.43, 95% CI 1.18-1.74).

Conclusions

In a large cohort of adults aged 65 years and older, neither antipsychotic or antidepressant drug use was associated with an increased risk of venous thromboembolism, with the exception of a slightly increased risk among those prescribed butyrophenones. Further data are required before use of these psychoactive drugs can be considered a risk factor for venous thromboembolism.

Keywords

Antipsychotics - antidepressants - drugs - deep vein thrombosis - pulmonary - embolism - venous thromboembolism - thrombosis - risk - cohort study

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