Published 28 August 2008, doi:10.1136/bmj.a1227
Cite this as: BMJ 2008;337:a1227

Research

Exposure to antipsychotics and risk of stroke: self controlled case series study

¹ Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT

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.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

Relevant Articles

The self controlled case series method

Heather Whitaker
BMJ 2008 337: a1069. [Extract] [Full Text]

Atypical antipsychotic drugs and risk of ischaemic stroke: population based retrospective cohort study

Sudeep S Gill, Paula A Rochon, Nathan Herrmann, Philip E Lee, Kathy Sykora, Nadia Gunraj, Sharon-Lise T Normand, Jerry H Gurwitz, Connie Marras, Walter P Wodchis, and Muhammad Mamdani
BMJ 2005 330: 445. [Abstract] [Full Text] [PDF]

Implementing guidelines on sudden infant death

Anne Livesey and Edmund Hick
BMJ 2004 328: 1262. [Extract] [Full Text]

This article has been cited by other articles:

• (2008). Antipsychotic Medication Increases Stroke Risk. JWatch Emergency Med. 2008: 5-5 [Full text]  
• (2008). Exposure to Antipsychotics and Risk for Stroke. JWatch General 2008: 1-1 [Full text]  
• Whitaker, H. (2008). The self controlled case series method. BMJ 337: a1069-a1069 [Full text]  

Rapid Responses:

Read all Rapid Responses

Effect of antipsychotics on stroke risk remains unproven

David Curtis
bmj.com, 31 Aug 2008 [Full text]

Where Are the Patient Counts?

David Behar
bmj.com, 1 Sep 2008 [Full text]

When we choose atypical antipsycotics?

giovanni portuesi
bmj.com, 3 Sep 2008 [Full text]

Awaiting a better explanation

Raghavendar Baburaj, et al.
bmj.com, 3 Sep 2008 [Full text]

What is medicine

Philipp Conradi
bmj.com, 5 Sep 2008 [Full text]

This article fails to control for smoking and is invalid.

Daniel J Pallin
bmj.com, 7 Sep 2008 [Full text]

Too many flaws to be of any clinical benifit

Daya Fernandopulle
bmj.com, 10 Sep 2008 [Full text]

Study does not discriminate between treatment and indication for treamtent as risk factor for stroke

Glen D Harper
bmj.com, 14 Sep 2008 [Full text]

The study does not establish any new information

Santhana K Gunasekaran, et al.
bmj.com, 15 Sep 2008 [Full text]

Is Socrates a woman?

Liz Miller
bmj.com, 15 Sep 2008 [Full text]