Exposure to antipsychotics and risk of stroke: self controlled case series study
Exposure to antipsychotics and risk of stroke: self controlled case series study
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DOI：
10.1136/bmj.a1227
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发表时间：
2008-09-13
影响因子：
--
通讯作者：
Smeeth, Liam
中科院分区：
文献类型：
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作者：
Douglas, Ian J.;Smeeth, Liam
目的探讨典型和非典型抗精神病药物的使用与痴呆和非痴呆患者脑卒中发病率的关系，设计自身对照病例系列，在全科医学研究数据库（GPRD）中建立基于英国的电子初级保健记录参与者在2002年底之前，所有在数据库中登记的有记录的中风事件和至少一个抗精神病药物处方的患者：6790名符合条件的参与者被确定并纳入最终分析。主要结果测量暴露于抗精神病药物的时间段与未暴露时间段相比卒中的比率。结果使用任何抗精神病药物与卒中的比率为1.73（95%置信区间1.60 - 1.87）：典型抗精神病药物为1.69（1.55 - 1.84），非典型抗精神病药物为2.32（1.73 - 3.10）。在接受任何抗精神病药物治疗的患者中，痴呆患者的比率为3.50（2.97至4.12），非痴呆患者的比率为1.41（1.29至1.55）。结论所有抗精神病药物均与卒中风险增加相关，接受非典型抗精神病药物治疗的患者的风险可能高于接受典型抗精神病药物治疗的患者。痴呆症患者似乎比非痴呆症患者发生相关中风的风险更高，在可能的情况下，这些患者应避免使用抗精神病药物。
Objectives To investigate the association between use of typical and atypical antipsychotic drugs and incidence of stroke in patients with and without dementia.Design Self controlled case series.Setting UK based electronic primary care records in the general practice research database ( GPRD).Participants All patients registered in the database with a recorded incident stroke and at least one prescription for any antipsychotic drug before the end of 2002: 6790 eligible participants were identified and included in the final analysis.Main outcome measures Rate ratio for stroke in periods of time exposed to antipsychotics compared with unexposed periods.Results Use of any antipsychotic drug was associated with a rate ratio for stroke of 1.73 ( 95% confidence interval 1.60 to 1.87): 1.69 ( 1.55 to 1.84) for typical antipsychotics and 2.32 ( 1.73 to 3.10) for atypical antipsychotics. In patients receiving any antipsychotic drug, the rate ratios were 3.50 ( 2.97 to 4.12) for those with dementia and 1.41 ( 1.29 to 1.55) for those without dementia.Conclusions All antipsychotics are associated with an increased risk of stroke, and the risk might be higher in patients receiving atypical antipsychotics than those receiving typical antipsychotics. People with dementia seem to be at a higher risk of an associated stroke than people without dementia and use of antipsychotics should, when possible, be avoided in these patients.