Clozapine associated pulmonary embolism: systematic review

Area of Science:

• Pharmacology
• Pulmonology
• Psychiatry

Background:

• Clozapine is a second-generation antipsychotic vital for treating refractory schizophrenia.
• Potential mechanisms linking clozapine to pulmonary embolism (PE) include immobility, weight gain, and heightened platelet aggregation.

Purpose of the Study:

• To systematically review documented cases of pulmonary embolism (PE) in patients treated with clozapine.

Main Methods:

• A comprehensive literature search was conducted across Medline, Embase, and Cochrane Library databases.
• The review encompassed published articles from the inception of these databases until June 2017.

Main Results:

• The analysis included 34 cases of PE associated with clozapine from 24 articles.
• Nearly half of the patients (47.82%) had no identifiable PE risk factors other than clozapine use.
• A significant mortality rate of 36.36% was observed, with clozapine discontinuation in 14 out of 18 patients with available follow-up data.

Conclusions:

• Pulmonary embolism (PE) associated with clozapine can manifest at dosages below the typical 300 mg daily threshold.
• Clinicians should maintain a high index of suspicion for PE in patients on clozapine, especially those lacking other conventional risk factors.