No Increased Stroke Risk for Users of Typical Antipsychotics

Women pouring medicine into hand.
Typical antipsychotic use is not associated with an increased risk for strokes compared with atypical antipsychotic use in a non-elderly population and patients without dementia.

Typical antipsychotic use is not associated with an increased risk for strokes compared with atypical antipsychotic use in a non-elderly and non-demented US population, according to study results published in the Journal of Clinical Psychiatry. Previous studies found that in elderly and demented populations there was an increased risk for strokes associated with typical antipsychotic use compared with atypical antipsychotic use.

In order to evaluate stroke risk in antipsychotic medication users from non-elderly and non-demented populations, researchers evaluated data from 45,495 typical antipsychotic agent users matched 1:1 to atypical antipsychotic medication users. Participants age 18 to 64 years who did not have dementia were identified using electronic health care data from 13 health plans participating in the Sentinel System. Researchers used ICD-9-CM diagnostic criteria to identify the risk for hospitalized stroke events, and compared the data between typical and atypical antipsychotic users with 1:1 propensity score matching. Then they estimated adjusted hazard ratios and 95% CIs during the follow-up period and separately associated the risk associated with haloperidol along.

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The unmatched hazard ratios suggested an increased stroke risk in  new users of typical antipsychotic agents compared with new users of atypical antipsychotic agents, but after matching during the complete follow-up period there was no increased risk observed (hazard ratio [HR], 0.87; 95% CI, 0.54-1.41). There were no greater risks observed in typical antipsychotic medication users during the risk windows of 1 to 15 days and 16 to 90 days after treatment initiation (HR, 1.16; 95% CI, 0.41-3.32 vs HR, 0.52; 95% CI, 0.20-1.36).]

The study was limited by the removal of many atypical antipsychotic users from the adjusted analyses, due to the 1:1 propensity score matching. This exclusion may reduce the generalizability of the findings. In addition, there was a lack of data regarding which antipsychotics had been prescribed.

Researchers concluded, “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 LG, Panucci G, Mosholder AD, Toh S, Huang TY. Antipsychotic use and stroke: a retrospective comparative study in a non- elderly population. J Clin Psychiatry. 2019;80(4):18m12636.