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Typical antipsychotics may not increase stroke risk in younger patients

Results from a retrospective comparative study did not indicate an increased risk for stroke in typical vs. atypical antipsychotic users in a nonelderly population without dementia.

These findings, published in Journal of Clinical Psychiatry, suggest that an increased risk for stroke previously observed in elderly populations taking typical antipsychotics may not exist in younger, generally healthier patients, according to the researchers.

“Despite the fact that younger adults commonly use [antipsychotics], the occurrence of stroke among nonelderly users of antipsychotics has remained largely unexamined,” Lockwood G. Taylor, PhD, deputy director in the division of epidemiology at FDA, and colleagues wrote.

Using electronic health care data from January 2001 to September 2015, researchers examined the risk for stroke among new users of typical vs. atypical antipsychotics in a younger population of U.S. patients aged 18 to 64 years without dementia. They compared the risk for hospitalized stroke events between typical and atypical antipsychotic users over the entire follow-up period as well as 1 to 15 days and 16 to 90 days after antipsychotic initiation and among haloperidol users alone.

The study included 45,495 new users of typical antipsychotics and 806,611 new users of atypical antipsychotics. The crude incidence rates of stroke events the study population were 2.5 and 1.2 events per 1,000 person-years for typical and atypical antipsychotic users, respectively.

Unmatched, site-adjusted HRs indicated an elevated risk for stroke among typical antipsychotic users compared to atypical antipsychotic users. However, Taylor and colleagues found no increased risk after propensity score matching during the entire follow-up period (HR = 0.87; 95% CI, 0.54-1.41), 1 to 15 days after medication initiation (HR = 1.16; 95% CI, 0.41–3.32) or 16 to 90 days after initiation (HR = 0.52; 95% CI, 0.2-1.36). In propensity score-matched analysis, the adjusted HR for haloperidol was 1.31 (95% CI, 0.54-3.21).

“Although patients treated with antipsychotics may be different from the general population of a similar age, our results suggest that users of antipsychotics might not have a notably higher risk of stroke than the general population,” Taylor and colleagues wrote.

Disclosure: The authors report no relevant financial disclosures.