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.