Antipsychotics and the Risk of Cerebrovascular Accident: A Systematic Review and Meta-Analysis of Observational Studies

Abstract

Background: Studies investigating the association between antipsychotic use and the risk of cerebrovascular accident (CVA) showed inconsistent results.

Aim: Conduct a systematic review and meta-analysis to evaluate whether use of antipsychotics is associated with increased risk of CVA.

Methods: Major electronic databases were searched from 1970 to October 2016 for observational studies investigating the risk of CVA among users of antipsychotics. Pooled estimates of odds ratios (ORs) and 95% confidence intervals (CIs) were obtained by random effects meta-analysis.

Results: Of 1171 citations identified, 10 studies were considered eligible. Significant increase in risk of CVA was associated with first-generation antipsychotics (OR 1.49; 95% CI 1.24-1.77) but not with second-generation antipsychotics (OR 1.31; 95% CI 0.74-2.30). Use of any antipsychotics in patients with dementia was associated with a low risk of CVA (OR 1.17; 95% CI 1.08-1.26).

Conclusions: The available evidence suggests use of with first-generation antipsychotics as opposed to second-generation antipsychotics significantly increased the risk of CVA.

Keywords: Antipsychotics; atypical antipsychotics; cerebrovascular accident; conventional antipsychotics; dementia; first-generation antipsychotics; hemorrhagic stroke; ischemic stroke; second-generation antipsychotics; stroke; transient ischemic attack.