Hypercoagulable state in patients with schizophrenia: different effects of acute and chronic antipsychotic medications

Caiji Zheng; Haiyan Liu; Weifeng Tu; Lingyun Lin; Haiyun Xu

doi:10.1177/20451253231200257

Hypercoagulable state in patients with schizophrenia: different effects of acute and chronic antipsychotic medications

Ther Adv Psychopharmacol. 2023 Sep 27:13:20451253231200257. doi: 10.1177/20451253231200257. eCollection 2023.

Authors

Caiji Zheng^{1

2

3}, Haiyan Liu^{4

2}, Weifeng Tu³, Lingyun Lin^{5

1

2}, Haiyun Xu⁶

Affiliations

¹ Mental Health Center of Shantou University, Shantou 515065, China.
² Shantou University Medical College - Faculty of Medicine of University of Manitoba Joint Laboratory of Biological Psychiatry, Shantou 515065, China.
³ Shenzhen Mental Health Center/Shenzhen Kangning Hospital, Shenzhen 518020, China.
⁴ Mental Health Center, Shantou University Medical College, Shantou, 515065, China.
⁵ Mental Health Center, Shantou University Medical College, Shantou, China.
⁶ School of Mental Health, Zhejiang Provincial Clinical Research Center for Mental Illness, Affiliated Kangning Hospital, Wenzhou Medical University, Wenzhou 325035, China.

Abstract

Background: Previous studies reported higher incidences of venous thromboembolism and cardiovascular disease in schizophrenia patients and higher indicators of thrombosis, thrombocyte activation, and platelet dysfunction.

Objectives: To check if first-episode schizophrenia (FES) patients have a hypercoagulable state and determine whether acute and chronic antipsychotics have the same effect on blood coagulation or fibrinolysis-related biomarkers.

Design: Case-control study.

Methods: A total of 81 participants were grouped in FES, chronic schizophrenia (CS), and healthy controls (HCs). In addition to demographic data and clinical characteristics, immunological analyses were performed to measure plasma levels of D-dimer, plasminogen activator inhibitor-1 (PAI-1), soluble P selectin (sP-sel), tissue plasminogen activator (tPA), thrombotic precursor protein (TpP), and von Willebrand's disease factor (vWF).

Results: Compared to HC group, FES patients showed higher PAI-1 (28.61 ng/ml versus 15.69 ng/ml), sP-sel (2.78 ng/ml versus 1.18 ng/ml), and TpP (15.61 µg/ml versus 5.59 µg/ml) along with a higher PAI-1/tPA (3.12 versus 2.00). Acute antipsychotic medication reduced higher PAI-1 (28.61 → 21.99), sP-sel (2.78 → 1.87), tPA (9.59 → 5.83), TpP (15.61 → 10.54), and vWF (383.18 → 291.08) in FES patients. However, plasma sP-sel and vWF in CS patients returned to the pre-treatment levels in FES patients, and PAI-1/tPA significantly decreased compared to FES patients.

Conclusion: These results suggest a hypercoagulable state in FES patients and demonstrate contrast effects of acute and chronic antipsychotics on coagulation or fibrinolysis in schizophrenia patients.

Keywords: antipsychotics; coagulation; hypercoagulability; schizophrenia; venous thromboembolisms.