ANTIPSYCHOTIC USE AND RISK OF ISCHEMIC STROKE IN ATRIAL FIBRILLATION PATIENTS WITH DEMENTIA
Author(s)
Zhen-Fang L. Lin, PhD.
National Taiwan University, Taipei, Taiwan.
National Taiwan University, Taipei, Taiwan.
OBJECTIVES: Compare the stroke risk between typical and atypical antipsychotic use in patients with AF and dementia. Investigate the effect of individual antipsychotic use on the risk of stroke in patients with AF and dementia. Evaluate the dose-response relationship of antipsychotic use in patients with AF and dementia.
METHODS: The present study conducted a retrospective cohort study with data from National Health Insurance Research Database (NHIRD). The cohort consisted of patients with AF and dementia. In non-users study, the risk of ischemic stroke associated with the use ofantipsychotic drugs was evaluated by using an adjusted multivariate Cox proportional hazards model with time-varying covariates with non-users as the reference. The adjusted Cox regression model was also used for comparative risk between the class of antipsychotics and across individual antipsychotics.
RESULTS: Of the cohort, atypical antipsychotic especially quetiapine was the most commonly prescribed antipsychotic drugs followed by haloperidol and risperidone among patients with AF and dementia. Antipsychotic users were associated with almost 1.3 times increased risk of stroke (HR=1.293, 95% CI, 1.095-1.527) compared with non-users in patients with AF and dementia. Patients treated with atypical antipsychotic had a significantly lower risk of ischemic stroke (HR=0.763, 95% CI, 0.625-0.931) than typical antipsychotic. Compared with haloperidol, patients receiving quetiapine (HR=0.689, 95% CI, 0.547-0.868) and risperidone (HR=0.755, 95% CI, 0.578-0.988) were significantly associated with lower risk of ischemic stroke.
CONCLUSIONS: Atypical antipsychotic especially quetiapine had lower hazard ratios compared to other antipsychotics. Although the study cannot prove causality, the findings provide more evidence of the risk, assisting in decision making for clinicians considering antipsychotic for the treatment of BPSD in patients with AF and dementia. When the use of antipsychotic is inevitable, the study suggests prescribing quetiapine in lower possible dose in this population who possess the preexisting high risk of stroke.
METHODS: The present study conducted a retrospective cohort study with data from National Health Insurance Research Database (NHIRD). The cohort consisted of patients with AF and dementia. In non-users study, the risk of ischemic stroke associated with the use ofantipsychotic drugs was evaluated by using an adjusted multivariate Cox proportional hazards model with time-varying covariates with non-users as the reference. The adjusted Cox regression model was also used for comparative risk between the class of antipsychotics and across individual antipsychotics.
RESULTS: Of the cohort, atypical antipsychotic especially quetiapine was the most commonly prescribed antipsychotic drugs followed by haloperidol and risperidone among patients with AF and dementia. Antipsychotic users were associated with almost 1.3 times increased risk of stroke (HR=1.293, 95% CI, 1.095-1.527) compared with non-users in patients with AF and dementia. Patients treated with atypical antipsychotic had a significantly lower risk of ischemic stroke (HR=0.763, 95% CI, 0.625-0.931) than typical antipsychotic. Compared with haloperidol, patients receiving quetiapine (HR=0.689, 95% CI, 0.547-0.868) and risperidone (HR=0.755, 95% CI, 0.578-0.988) were significantly associated with lower risk of ischemic stroke.
CONCLUSIONS: Atypical antipsychotic especially quetiapine had lower hazard ratios compared to other antipsychotics. Although the study cannot prove causality, the findings provide more evidence of the risk, assisting in decision making for clinicians considering antipsychotic for the treatment of BPSD in patients with AF and dementia. When the use of antipsychotic is inevitable, the study suggests prescribing quetiapine in lower possible dose in this population who possess the preexisting high risk of stroke.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
RWD41
Topic
Epidemiology & Public Health, Health Policy & Regulatory, Real World Data & Information Systems
Topic Subcategory
Data Protection, Integrity, & Quality Assurance
Disease
Cardiovascular Disorders (including MI, Stroke, Circulatory), Geriatrics, Mental Health (including addiction), Neurological Disorders, Personalized & Precision Medicine