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Rosa Liperoti, MD, MPH; Claudio Pedone, MD, PhD, MPH; Kate L. Lapane, PhD; Vincent Mor, PhD; Roberto Bernabei, MD; Giovanni Gambassi, MD

Arch Intern Med. 2005;165:2677-2682.

Background  Some antipsychotic agents have been indicated as a possible risk factor for venous thromboembolism (VTE) in adult patients with psychiatric disorders. The aim of this study was to estimate the effect of atypical and conventional antipsychotic agents on the risk of hospitalization for VTE among elderly patients.

Methods  We conducted a retrospective cohort study on nursing home residents in 5 states. We used data from the Minimum Data Set to identify 19 940 new users of antipsychotic agents and 112 078 nonusers. Hospitalization with VTE as primary discharge diagnosis was determined during a 6-month follow-up period using Medicare inpatient claims. Cox proportional hazards models provided estimates of effect adjusted for confounders.

Results  The rate of hospitalization for VTE was 0.91 per 100 person-years. Venous thrombosis accounted for 77.6% of events and 22.4% were pulmonary embolisms. Relative to nonusers, the rate of hospitalization for VTE was increased for users of atypical antipsychotic agents, including risperidone (adjusted hazard ratio [HR], 1.98; 95% confidence interval [CI], 1.40-2.78), olanzapine (adjusted HR, 1.87; 95% CI, 1.06-3.27), and clozapine and quetiapine fumarate (adjusted HR, 2.68; 95% CI, 1.15-6.28). No increased rate was associated with phenothiazines (adjusted HR, 1.03; 95% CI, 0.60-1.77) or other conventional agents (adjusted HR, 0.98; 95% CI, 0.52-1.87).

Conclusions  Atypical antipsychotic agents appear to increase the risk of VTE. However, these events are rare, and in clinical practice the absolute risk should be weighed against the effectiveness of these medications in the elderly population.

Author Affiliations: Centro di Medicina dell’Invecchiamento, Dipartimento di Scienze Gerontologiche, Geriatriche e Fisiatriche, Università Cattolica del Sacro Cuore (Drs Liperoti, Bernabei, and Gambassi), and Unit of Geriatrics, Università Campus Bio-Medico (Dr Pedone), Rome, Italy; and Department of Community Health, Center for Gerontology and Health Care Research (Dr Mor), Department of Community Health, Center for Gerontology and Health Care Research, Brown Medical School (Drs Lapane, Mor, and Gambassi), Providence, RI.

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