| Background: Antipsychotic agents(APS)are widely used drugs to treat schizophrenia,bipolar disorder and major depression disorder with psychotic symptoms.For decades,some studies suggested that there is a relationship between using APS and the risk of venous thromboembolism(VTE)and pulmonary embolism(PE).However,results remain inconclusive.Method: This review has been registered in International Prospective Register of Systematic Reviews(PROSPERO,ID: CDR42020155620).Relevant studies were identified among observational studies published up to 1 October 2019 in the databases MEDLINE,EMBASE,and Cochrane Library.Newcastle-Ottawa Scale is used to assess the quality of methodology of inclusion studies.Software Review Manager 5.2is used to perform the statistical analysis.Random or fixed-effects models were used to calculate the pooled odds ratio(OR).Results: In total,28 observational studies were included.The results showed that compared to non-users,current APS users have significantly increased risks of VTE(OR 1.55 95% CI 1.36,1.76)and PE(OR 3.68,95% CI 1.23,11.05).However,the heterogeneity of inclusion studies is significantly high(VTE: P < 0.00001,I2 = 85%;PE: P < 0.00001,I2 = 90%).Subgroup analyses suggested that new users were associated with a higher risk of VTE(OR 2.06,95% CI 1.81,2.35).For individual drugs,increased risk of VTE and PE was observed in taking haloperidol(OR 1.64 95%CI 1.20,2.23),risperidone(OR 1.63 95%CI 1.16,2.31),olanzapine(OR 1.63 95%CI1.12,2.37),prochlorperazine(OR 1.90 95%CI 1.06,3.40)but not in chlorpromazine(OR 1.36 95%CI 0.98,1.87),quetiapine(OR 1.61 95%CI 0.57,4.55)or aripiprazole(OR 2.79 95%CI 0.31,25.37).Conclusion: The present comprehensive meta-analysis further indicates a significantly increased risk of VTE and PE in current APS users compared with non-users.Subgroup analyses suggest that new users are more likely to develop VTE.However,due to significant heterogeneity among studies,conclusions should be considered with caution. |
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