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

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.