Antipsychotics Up Clot Risk
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As dementia such as Alzheimer's progresses in a person, antipsychotic medications are commonly prescribed to treat symptoms. Research published by the BMJ suggests that taking newer antipsychotic drugs could increase the chances of developing dangerous blood clots.
This large and important study adds to the growing body of evidence which suggests antipsychotic drugs increase the risk of deep vein thrombosis and pulmonary embolism, and adds significantly to understanding of the serious detrimental effects of antipsychotics to the health of people with dementia.
Details of the Study
There was already limited evidence that antipsychotic drugs, some of which are also prescribed for nausea, vomiting and vertigo, may be associated with an increased risk of venous thromboembolism.
Previous studies, however, have been small and restricted to certain population groups, or have not included newer ‘atypical’ antipsychotic drugs.
Researchers from The University of Nottingham and the Nottinghamshire County Teaching Primary Care Trust examined how these drugs affected people taking them, looking at the type of drug used, and the potency and dose involved.
Data for this study came from the UK QResearch primary care database, which holds the anonymised primary care clinical records of more than 11 million people registered at any time in the past 16 years with 525 UK general practices.
The Nottingham researchers, led by Professor Julia Hippisley-Cox at The University of Nottingham, looked at 25,532 eligible cases — 15,975 with deep vein thrombosis and 9,557 pulmonary embolism — recorded between 1996 and 2007 in people aged between 16 and 100.
The cases were compared with 89,491 controls and showed that people prescribed antipsychotics in the previous 24 months had a 32 per cent greater risk of venous thromboembolism than non-users, even after adjusting for potential risk factors.
Who is at Risk?
Risks were higher for new users, the researchers found, as patients who had started a new drug in the previous three months, had about twice the risk.
The risk was even greater for individuals prescribed atypical rather than conventional drugs. It also tended to be greater for patients prescribed low rather than high potency drugs.
However, the authors point out that the absolute risks were low, with an excess of four extra cases of venous thromboembolism per 10,000 patients treated over one year in patients of all ages, and 10 for patients aged 65 and over.
They conclude: “Though these findings add to the accumulating evidence of adverse health events associated with antipsychotic drugs, they should be confirmed with other data sources.
“If other studies replicate these findings, antipsychotic drugs should be used more cautiously... Patients need information on the balance of risks and benefits of these drugs before they start treatment.”
Alzheimer's Society Comment
Professor Clive Ballard, Director of Research at England's Alzheimer's Society, stated that the "Alzheimer's Society believes, beyond a shadow of a doubt that antipsychotic drugs should only ever be used as a last resort for people with dementia."
"The massive over-prescription of antipsychotics to people with dementia leads to an estimated 1,800 deaths a year - this must end. These drugs double the risk of death, triple the risk of stroke and accelerate cognitive decline. The drugs also have a profound effect on quality of life, leaving people heavily sedated."
"Training staff in dementia care can increase their understanding of the condition and eliminate the need for antipsychotics. Training must be made an immediate priority. It also is of paramount importance to develop safe alternative treatments for distressing behavioural symptoms in people with dementia."
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10/3/2010 My Mom uses Zyprexa and has used it for the last 3 years. The doctor keeps her at a low dose taken twice a day and Mom has maintained a very even tempered personality. She is now going toward the latter stages of Alzheimer's. Her doctor told us that the risk of venous thromboembolism is during the first 3 months of taking the drug. I do not like the drug but it has been a great help for my Mom so far.
This British study was not a blind study, it was mining previous paper records. And, even the people doing the study admit that the risk is low -- quote "However, the authors point out that the absolute risks were low with an excess of 4 extra cases of venous thromboembolism per 10,000 patients treated one year in patients of all ages, and 10 patients aged 65 and over." AND, they admit more studies are needed.
I agree that antipsychotic drugs should be used as a last resort. But, sometimes they are needed and do provide positive results for the patient. I am glad Mom's doctor decided to use Zyprexa. NancyA