The highlights of 3 new clinical studies involving stroke include older adults who take atypical antipsychotics have an increased risk of major cardiovascular events, particularly stroke; thrombectomy may be effective up to 24 hours after stroke onset; and elderly adults can safely undergo endovascular therapy to treat acute ischemic stroke.
Study 1: Antipsychotics Lead to Higher Incidence of Stroke
Long-term use of atypical antipsychotics may lead to major cardiovascular events, including stroke, in older patients.
A retrospective cohort study included 1008 patients, mean age 72.4 years, who were followed for a median of 36.5 months to evaluate the effect of antipsychotic medications categorized by their metabolic side effect profiles as low, intermediate, or high risk on major cardiovascular events. The primary outcome measure was the time to the composite of acute myocardial infarction, acute coronary syndrome, ischemic stroke, peripheral artery disease, or a new revascularization procedure.
Those taking second-generation antipsychotics who experienced a high level or an intermediate level of metabolic changes had an almost threefold increased risk of experiencing a cardiovascular event, in particular, stroke, as compared to those taking medications associated with a lower risk for metabolic changes.
“Older adult patients under antipsychotic regimens with high or intermediate risk of metabolic side effects may face a higher incidence of major cardiovascular events than those under a low-risk regimen during long-term follow-up,” stated the researchers. The higher risk for major cardiovascular events among those taking intermediate-risk or high-risk agents appears to be mostly driven by the higher risk of stroke, which may be due to high prevalence of patients with dementia or related to potential direct or indirect effects of antipsychotics.
Szmulewicz AG, et al. Long-Term Antipsychotic Use and Major Cardiovascular Events: A Retrospective Cohort Study. J Clin Psychiatry 2017;78(8):e905–e912. 10.4088/JCP.16m10976
Study 2 on the next page >