A Review of Antipsychotic Medications on Hypercoagulability in Schizophrenia: Pathophysiology, Risks, and Management Strategies
Dita Hasni1*, Debie Anggraini2, Mutiara Anissa3
Journal of Angiotherapy 8(12) 1-8 https://doi.org/10.25163/angiotherapy.81210063
Submitted: 30 September 2024 Revised: 04 December 2024 Published: 05 December 2024
Abstract
Background: Schizophrenia is a severe psychiatric disorder with a global prevalence of 0.3-0.7%, characterized by symptoms like delusions, hallucinations, and cognitive deficits. Treatment typically involves antipsychotic medications, which are divided into typical (first-generation) and atypical (second-generation) categories. While effective for symptom control, these medications are associated with a range of adverse effects, including metabolic disturbances and hypercoagulability, which increase the risk of thromboembolic events. This review explores the mechanisms linking antipsychotic treatment to coagulation disorders and identifies strategies to mitigate these risks. Methods: A comprehensive review of existing literature was conducted, focusing on the pathophysiological mechanisms by which antipsychotics impact coagulation pathways. Data were drawn from clinical studies, case reports, and meta-analyses that evaluated the relationship between antipsychotic use and the occurrence of thromboembolic events. Mechanisms such as endothelial dysfunction, platelet activation, and chronic inflammation were explored. Results: Antipsychotic medications, particularly atypical antipsychotics like clozapine, olanzapine, and risperidone, are associated with significant metabolic disturbances, including weight gain, insulin resistance, and dyslipidemia, which predispose patients to a pro-thrombotic state. Elevated levels of inflammatory markers and endothelial dysfunction further exacerbate thromboembolic risks. Clinical evidence confirms an increased incidence of venous thromboembolism (VTE) and ischemic stroke among patients on antipsychotic medications, with SGAs showing a higher thromboembolic risk compared to FGAs. Conclusion: Schizophrenia patients treated with antipsychotic medications are at an elevated risk of coagulation disorders, particularly thromboembolic events. Clinicians should monitor metabolic and coagulation parameters and adopt a holistic approach to treatment that includes lifestyle interventions and pharmacological management of metabolic disturbances. Further research is needed to explore targeted therapies that can reduce thromboembolic risks associated with antipsychotic treatment.
Keywords: Antipsychotic Drug; Hypercoagulability; Schizophrenia; Venous Thromboembolism; Metabolic Syndrome
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