Discussion
Psychiatric disorders such as schizophrenia, anxiety disorder, depression disorder, bipolar disorder, etc., are bringing heavy disease burden and social burdens to more and more people. Take schizophrenia as an example, which is among the most disabling and economically catastrophic medical disorders. Schizophrenia occurs throughout the World. The prevalence of schizophrenia approaches 1 percent internationally. The number of new cases annually is about 1.5 per 10, 000 people [13]. Medication is the primary treatment method for schizophrenia.
Antipsychotics are divided into traditional antipsychotics (first-generation antipsychotics FGAs) and atypical antipsychotics (second-generation antipsychotics SGAs). SGAs generally have a lower risk of extrapyramidal symptoms and tardive dyskinesia than FGAs. VTE is a rare but severe adverse drug reaction to antipsychotics. VTE is one of the causes of sudden death in many psychiatric patients, and many studies revealed the association between antipsychotic drugs and VTE. Some studies have reported that there is an association between psychotropic drug use and the occurrence of VTE[14-25].
A systematic review of 28 observational studies published in 2021 showed that the risk of VTE was 1.55 times that of those who did not use antipsychotic drugs, and the risk of PE was 3.68 times that of those who did not use antipsychotic drugs, indicating that antipsychotic drugs significantly increased VTE risk, especially the risk of PE[26]. One study of psychiatric hospitals in Europe showed that risperidone (55/100, 000) and pipamperone (61/100, 000) were the most common examples of antipsychotics causing VTE in hospitalized psychotic patients [27].
At present, the underline mechanisms of VTE caused by antipsychotics are unknown, and no single cause can fully explain this drug-induced disease[28-29]. The hypotheses include that sedation, weight gain, and hyperprolactinemia induced by psychotropic drugs may increase the risk of VTE. Paliperidone and risperidone have the double blocking effect of the dopamine 2(D2) receptor and serotonin 2 receptor, and compared with other antipsychotic drugs, paliperidone, and risperidone have a strong antagonistic effect on dopamine. Dopamine is the main prolactin inhibitor, and dopamine inhibition can lead to high prolactin lipids. Prolactin may affect platelet aggregation. But platelet aggregation mainly leads to arterial clots, not venous clots. But VTE patients with acute psychosis may be induced by pathogenic mechanisms related to psychosis rather than by antipsychotic drugs. Thus, the mechanism by which antipsychotic drugs lead to venous thrombosis needs further study.