https://scholars.lib.ntu.edu.tw/handle/123456789/520477
Title: | Antipsychotic medications and stroke in schizophrenia: A case-crossover study | Authors: | Chen W.-Y. LIAN-YU CHEN Liu H.-C. CHI-SHIN WU Yang S.-Y. Pan C.-H. Tsai S.-Y. Chen C.-C. Kuo C.-J. |
Issue Date: | 2017 | Journal Volume: | 12 | Journal Issue: | 6 | Start page/Pages: | e0179424 | Source: | PLoS ONE | Abstract: | Background: The association between antipsychotic use and the risk of stroke in schizophrenic patients is controversial. We sought to study the association in a nationwide cohort with schizophrenia. Methods: Using a retrospective cohort of patients with schizophrenia (N = 31,976) derived from the Taiwan National Health Insurance Research Database, 802 new-onset cases of stroke were identified within 10 years of follow-up (from 2000 through 2010). We designed a casecrossover study using 14-day windows to explore the risk factors of stroke and the association between antipsychotic drugs and the risk of stroke. We analyzed the risks of individual antipsychotics on various subgroups of stroke including ischemic, hemorrhagic, and other strokes, and the risks based on the antipsychotic receptor-binding profile of each drug. Results: Use of any second-generation antipsychotic was associated with an increased risk of stroke (adjusted risk ratio = 1.45, P = .009) within 14 days while the use of any first-generation antipsychotic was not. Intriguingly, the use of any second-generation antipsychotic was associated with ischemic stroke but not hemorrhagic stroke. The antipsychotic receptor-binding profile analysis showed that the antihistamine 1 receptor was significantly associated with ischemic stroke (adjusted risk ratio = 1.72, P = .037), and the sensitivity analysis based on the 7-day window of exposure validated the association (adjusted risk ratio = 1.87, P = .015). Conclusions: Use of second-generation antipsychotic drugs appeared to be associated with an increased risk of ischemic stroke in the patients studied, possibly mediated by high affinity for histamine-1 receptor blockade. Further research regarding the underlying biological mechanism and drug safety is suggested. ? 2017 Chen et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. |
URI: | https://www.scopus.com/inward/record.uri?eid=2-s2.0-85020754945&doi=10.1371%2fjournal.pone.0179424&partnerID=40&md5=d184b129dc87921ce21d185638cbcd11 https://scholars.lib.ntu.edu.tw/handle/123456789/520477 |
ISSN: | 1932-6203 | DOI: | 10.1371/journal.pone.0179424 | SDG/Keyword: | amisulpride; antihistaminic agent; aripiprazole; carbamazepine; chlorpromazine; clozapine; flupentixol; haloperidol; lithium; neuroleptic agent; olanzapine; quetiapine; risperidone; sulpiride; valproic acid; zotepine; neuroleptic agent; adult; aged; Article; brain hemorrhage; brain ischemia; case study; cerebrovascular accident; cohort analysis; controlled study; drug effect; drug exposure; female; follow up; human; major clinical study; male; middle aged; receptor binding; retrospective study; risk factor; schizophrenia; sensitivity analysis; adolescent; Asian continental ancestry group; chemically induced; crossover procedure; ethnology; factual database; incidence; multivariate analysis; procedures; public health; risk assessment; schizophrenia; statistical model; statistics and numerical data; Stroke; Taiwan; time factor; young adult; Adolescent; Adult; Aged; Antipsychotic Agents; Asian Continental Ancestry Group; Cross-Over Studies; Databases, Factual; Female; Follow-Up Studies; Humans; Incidence; Logistic Models; Male; Middle Aged; Multivariate Analysis; National Health Programs; Retrospective Studies; Risk Assessment; Risk Factors; Schizophrenia; Stroke; Taiwan; Time Factors; Young Adult |
Appears in Collections: | 流行病學與預防醫學研究所 |
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