Antipsychotics and the Risk of Cerebrovascular Accident: A Systematic Review and Meta-Analysis of Observational Studies

Wan Ting Hsu; Amin Esmaily-Fard; Chih Cheng Lai; Darshan Zala; Sie Huei Lee; Shy Shin Chang; Chien Chang Lee

doi:10.1016/j.jamda.2017.02.020

Antipsychotics and the Risk of Cerebrovascular Accident: A Systematic Review and Meta-Analysis of Observational Studies

Wan Ting Hsu, Amin Esmaily-Fard, Chih Cheng Lai, Darshan Zala, Sie Huei Lee, Shy Shin Chang, Chien Chang Lee

Research output: Contribution to journal › Article › peer-review

41 Citations (Scopus)

Abstract

Background Studies investigating the association between antipsychotic use and the risk of cerebrovascular accident (CVA) showed inconsistent results. Aim Conduct a systematic review and meta-analysis to evaluate whether use of antipsychotics is associated with increased risk of CVA. Methods Major electronic databases were searched from 1970 to October 2016 for observational studies investigating the risk of CVA among users of antipsychotics. Pooled estimates of odds ratios (ORs) and 95% confidence intervals (CIs) were obtained by random effects meta-analysis. Results Of 1171 citations identified, 10 studies were considered eligible. Significant increase in risk of CVA was associated with first-generation antipsychotics (OR 1.49; 95% CI 1.24–1.77) but not with second-generation antipsychotics (OR 1.31; 95% CI 0.74–2.30). Use of any antipsychotics in patients with dementia was associated with a low risk of CVA (OR 1.17; 95% CI 1.08–1.26). Conclusions The available evidence suggests use of with first-generation antipsychotics as opposed to second-generation antipsychotics significantly increased the risk of CVA.

Original language	English
Pages (from-to)	692-699
Number of pages	8
Journal	Journal of the American Medical Directors Association
Volume	18
Issue number	8
DOIs	https://doi.org/10.1016/j.jamda.2017.02.020
Publication status	Published - Aug 1 2017
Externally published	Yes

Keywords

Antipsychotics
atypical antipsychotics
cerebrovascular accident
conventional antipsychotics
dementia
first-generation antipsychotics
hemorrhagic stroke
ischemic stroke
second-generation antipsychotics
stroke
transient ischemic attack

ASJC Scopus subject areas

General Nursing
Health Policy
Geriatrics and Gerontology

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.1016/j.jamda.2017.02.020

Cite this

@article{c9a32f744f884f86a7a49cdf806702ef,

title = "Antipsychotics and the Risk of Cerebrovascular Accident: A Systematic Review and Meta-Analysis of Observational Studies",

abstract = "Background Studies investigating the association between antipsychotic use and the risk of cerebrovascular accident (CVA) showed inconsistent results. Aim Conduct a systematic review and meta-analysis to evaluate whether use of antipsychotics is associated with increased risk of CVA. Methods Major electronic databases were searched from 1970 to October 2016 for observational studies investigating the risk of CVA among users of antipsychotics. Pooled estimates of odds ratios (ORs) and 95% confidence intervals (CIs) were obtained by random effects meta-analysis. Results Of 1171 citations identified, 10 studies were considered eligible. Significant increase in risk of CVA was associated with first-generation antipsychotics (OR 1.49; 95% CI 1.24–1.77) but not with second-generation antipsychotics (OR 1.31; 95% CI 0.74–2.30). Use of any antipsychotics in patients with dementia was associated with a low risk of CVA (OR 1.17; 95% CI 1.08–1.26). Conclusions The available evidence suggests use of with first-generation antipsychotics as opposed to second-generation antipsychotics significantly increased the risk of CVA.",

keywords = "Antipsychotics, atypical antipsychotics, cerebrovascular accident, conventional antipsychotics, dementia, first-generation antipsychotics, hemorrhagic stroke, ischemic stroke, second-generation antipsychotics, stroke, transient ischemic attack",

author = "Hsu, {Wan Ting} and Amin Esmaily-Fard and Lai, {Chih Cheng} and Darshan Zala and Lee, {Sie Huei} and Chang, {Shy Shin} and Lee, {Chien Chang}",

note = "Publisher Copyright: {\textcopyright} 2017 AMDA – The Society for Post-Acute and Long-Term Care Medicine",

year = "2017",

month = aug,

day = "1",

doi = "10.1016/j.jamda.2017.02.020",

language = "English",

volume = "18",

pages = "692--699",

journal = "Journal of the American Medical Directors Association",

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T1 - Antipsychotics and the Risk of Cerebrovascular Accident

T2 - A Systematic Review and Meta-Analysis of Observational Studies

AU - Hsu, Wan Ting

AU - Esmaily-Fard, Amin

AU - Lai, Chih Cheng

AU - Zala, Darshan

AU - Lee, Sie Huei

AU - Chang, Shy Shin

AU - Lee, Chien Chang

PY - 2017/8/1

Y1 - 2017/8/1

N2 - Background Studies investigating the association between antipsychotic use and the risk of cerebrovascular accident (CVA) showed inconsistent results. Aim Conduct a systematic review and meta-analysis to evaluate whether use of antipsychotics is associated with increased risk of CVA. Methods Major electronic databases were searched from 1970 to October 2016 for observational studies investigating the risk of CVA among users of antipsychotics. Pooled estimates of odds ratios (ORs) and 95% confidence intervals (CIs) were obtained by random effects meta-analysis. Results Of 1171 citations identified, 10 studies were considered eligible. Significant increase in risk of CVA was associated with first-generation antipsychotics (OR 1.49; 95% CI 1.24–1.77) but not with second-generation antipsychotics (OR 1.31; 95% CI 0.74–2.30). Use of any antipsychotics in patients with dementia was associated with a low risk of CVA (OR 1.17; 95% CI 1.08–1.26). Conclusions The available evidence suggests use of with first-generation antipsychotics as opposed to second-generation antipsychotics significantly increased the risk of CVA.

AB - Background Studies investigating the association between antipsychotic use and the risk of cerebrovascular accident (CVA) showed inconsistent results. Aim Conduct a systematic review and meta-analysis to evaluate whether use of antipsychotics is associated with increased risk of CVA. Methods Major electronic databases were searched from 1970 to October 2016 for observational studies investigating the risk of CVA among users of antipsychotics. Pooled estimates of odds ratios (ORs) and 95% confidence intervals (CIs) were obtained by random effects meta-analysis. Results Of 1171 citations identified, 10 studies were considered eligible. Significant increase in risk of CVA was associated with first-generation antipsychotics (OR 1.49; 95% CI 1.24–1.77) but not with second-generation antipsychotics (OR 1.31; 95% CI 0.74–2.30). Use of any antipsychotics in patients with dementia was associated with a low risk of CVA (OR 1.17; 95% CI 1.08–1.26). Conclusions The available evidence suggests use of with first-generation antipsychotics as opposed to second-generation antipsychotics significantly increased the risk of CVA.

KW - Antipsychotics

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KW - conventional antipsychotics

KW - dementia

KW - first-generation antipsychotics

KW - hemorrhagic stroke

KW - ischemic stroke

KW - second-generation antipsychotics

KW - stroke

KW - transient ischemic attack

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