Clozapine associated pulmonary embolism: systematic review. Issue 4 (4th July 2019)

• Record Type: Journal Article
• Authors: Poudyal, Rakshya; Lohani, Saroj
• Is Part Of: Journal of community hospital internal medicine perspectives. Volume 9:Issue 4(2019)
• Page Start: 300
• Page End: 304
• Publication Date: 2019-07-04
• Subjects: Clozapine -- pulmonary embolism -- anticoagulation -- schizophrenia; Internal medicine -- Periodicals; Hospitals -- Periodicals; Hospitals, Community; Internal Medicine; Hospitals; Internal medicine; Periodicals; Periodicals; 610
• DOI: 10.1080/20009666.2019.1627848
• Languages: English
• ISSNs: 2000-9666

Abstract

ABSTRACT: Background : Clozapine is a second-generation antipsychotic used in refractory schizophrenia. Clozapine can lead to pulmonary embolism (PE) by various mechanisms including immobility, weight gain and increased platelet aggregation. Objectives : We performed a systematic review on published cases of PE associated with clozapine. Methods : Comprehensive search of Medline, Embase and Cochrane library was done for relevant articles from inception until June 2017 Results : Total of 34 cases from 24 articles were included in the analysis. The mean age was 43.2 years with male predominance (63.6%). The mean dosage of clozapine was 281.4 mg daily. Duration of intake ranged from few days to many years. Nearly half of patients (47.82%) had no other co-morbidities for PE other than clozapine. For those reporting treatment, anticoagulation was chosen in 80%, thrombolysis in 10% and inferior vena cava filter placement in 5%. Mortality was 36.36% with three dying on presentation and an additional 9 dying during the follow-up period. Of the 18 patients in which follow-up data of clozapine were available, the drug was discontinued in 14 patients. Conclusion : PE can occur at doses lower than usual dose of clozapine (300 mg daily). It is important to consider this association especially in patients with no other risk factors for PE.