Risk of Hospitalization for Stroke Associated with Antipsychotic Use in the Elderly A Self-Controlled Case Series
Risk of Hospitalization for Stroke Associated with Antipsychotic Use in the Elderly A Self-Controlled Case Series
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DOI：
10.2165/11584490-000000000-00000
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发表时间：
2010-01-01
期刊：
影响因子：
2.8
通讯作者：
Ryan, Philip
中科院分区：
文献类型：
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作者：
Pratt, Nicole L.;Roughead, Elizabeth E.;Ryan, Philip
背景抗精神病药物通常用于老年人，尽管缺乏随机试验的安全性数据，特别是典型的抗精神病药物。观察性研究调查了抗精神病药物与卒中之间的关系，但结果各不相同，这可能是由于缺乏对不可测量的混杂因素的控制。目的评估老年抗精神病药使用者因卒中住院的风险。研究设计和设置使用澳大利亚政府退伍军人事务部行政索赔数据集，我们利用自我对照病例系列设计来风险-调整潜在的不可测量的混杂因素，还包括抗精神病药物开始前的风险期，以根据适应症搜索混杂因素的证据。未暴露患者也包括在内，以调整随年龄增加的卒中住院发生率。在2003年1月1日至2006年12月31日的4年期间，确定了1例因卒中住院的患者。其中，514例患者开始使用典型抗精神病药物，564例患者开始使用非典型抗精神病药物。（发病率比[IRR] 2 3，95% CI 1 3，3 8）没有证据表明在开始非典型抗精神病药物治疗后因卒中住院的风险增加。在首次抗精神病药物治疗前的几周内因卒中住院的风险进行性增加。而在开始抗精神病药物治疗前一周因中风住院的风险显著增加，（IRR 7 2，95% CI 5 3，9 8），在同一时期开始使用非典型抗精神病药物的患者没有额外的风险（IRR 1 2，95% CI 0 7，（2 3）结论：本研究结果与随机对照试验证据一致，表明服用非典型抗精神病药物的患者发生需要住院治疗的严重脑血管事件的风险没有增加。在老年人中使用典型抗精神病药物的中风住院治疗该研究发现，在开始使用典型抗精神病药物后立即因中风住院治疗的风险小但显著增加。抗精神病药物可能在中风住院治疗后开始使用。该实践可能反映了在中风后并发症如谵妄住院期间开抗精神病药物的处方，然而，这种做法的长期影响是未知的
Background Antipsychotics are commonly used in the elderly despite a lack of safety data from randomized trials, particularly for the typical antipsychotics Observational studies have investigated the association between antipsychotics and stroke but results vary, which may be due to lack of control for unmeasured confoundingObjective To estimate the risk of hospitalization for stroke in elderly users of antipsychoticsStudy Design and Setting Using the Australian Government Department of Veterans' Affairs administrative claims dataset we utilized a self-controlled case series design to risk-adjust for potential unmeasured confounding Risk periods prior to antipsychotic initiation were also included to search for evidence of confounding by indication Unexposed patients were included to adjust for the increasing incidence of hospitalization for stroke with ageResults There were 10 638 patients aged 65 years with at least one hospitalization for stroke identified during the 4-year period from 1 January 2003 to 31 December 2006 Of these, 514 patients were initiated on typical antipsychotics and 564 patients were initiated on atypical antipsychotics Hospitalization for stroke was increased in the first week after initiation of a typical antipsychotic (incidence rate ratio [IRR] 2 3, 95% CI 1 3, 3 8) There was no evidence of an increased risk of hospitalization for stroke after initiation of atypical antipsychotics The risk of hospitalization for stroke progressively increased in the weeks leading up to first-time antipsychotic treatment However, while the risk of hospitalization for stroke in the week prior to initiating antipsychotic therapy was significantly increased for patients initiated on typical antipsychotics (IRR 7 2, 95% CI 5 3, 9 8), patients initiated on atypical antipsychotics had no excess risk in the same period (IRR 1 2, 95% CI 0 7, 2 3)Conclusions The results of this study are consistent with randomized controlled trial evidence indicating that there is no Increased risk of serious cerebrovascular events requiring hospitalization in patients taking atypical antipsychotics No randomized controlled trial evidence is available on the risk of hospitalization for stroke with use of typical antipsychotics in the elderly This study found a small but significantly increased risk of hospitalization for stroke immediately following the initiation of typical antipsychotics Antipsychotics are likely to be initiated after hospitalization for stroke This practice is likely to reflect the prescribing of antipsychotics during hospital admission for post-stroke complications such as delirium, however, the long-term effects of this practice are unknown