Fatal pulmonary embolism related to anti-psychotics: forensic implications. About four autopsy cases with review of the literature
Introduction The association between the intake of antipsychotic drugs and the occurrence of thromboembolic complications is widely described in the literature. The occurrence of this complication may call into question the medical responsibility of the attending physician. Objectives The objective...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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Cambridge University Press
2023-03-01
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| Series: | European Psychiatry |
| Online Access: | https://www.cambridge.org/core/product/identifier/S0924933823018679/type/journal_article |
| _version_ | 1797616540302966784 |
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| author | M. Kacem W. Bouali Y. Mahjoub S. Brahim L. Zarrouk |
| author_facet | M. Kacem W. Bouali Y. Mahjoub S. Brahim L. Zarrouk |
| author_sort | M. Kacem |
| collection | DOAJ |
| description |
Introduction
The association between the intake of antipsychotic drugs and the occurrence of thromboembolic complications is widely described in the literature. The occurrence of this complication may call into question the medical responsibility of the attending physician.
Objectives
The objective of this work is to describe the physiopathological mechanisms involved in the occurrence of thromboembolic complications in a patient under antipsychotic treatment, whether or not associated with physical restraint and to discuss the forensic implications.
Methods
Our study is retrospective on cases of fatal pulmonary embolism, discovered at autopsy, in connection with the taking of antipsychotics. The autopsies were carried out in the Department of Forensic Medicine of the Tahar Sfar University Hospital in Mahdia. The cases were collected over a period of 04 years. A review of the literature was carried out. We only selected articles published until February 2021 and dealing with cases of patients on antipsychotics, diagnosed with pulmonary embolism by performing a chest CT scan or during an autopsy.
Results
915 autopsy cases were performed during the study period. Twenty cases of pulmonary embolism, discovered at autopsy, were collected. Four cases were related to the taking of antipsychotics (incidence 0.004%), including two men and two women, aged between 25 and 52 years. They were all on antipsychotic treatment for at least 5 years, with the exception of one case who was put on 3 antipsychotics, 7 days before his death, with indication of physical restraint.
After analysis of the memorial data, the external examination and the autopsy, the results of additional examinations, the death was attributed, in the 4 cases, to a massive fibrino-cruoric pulmonary embolism.
A selection of 45 studies regarding thromboembolic complications associated with taking antipsychotics, was included in the final review.
Conclusions
The reported cases provided additional evidence on the involvement of antipsychotics in the occurrence of thromboembolic complications. Psychiatrists should be careful when prescribing these treatments. The establishment of therapeutic guidelines, taking into account the thromboembolic risk factors, becomes essential, in order to avoid the occurrence of a complication which could engage both the vital prognosis of patients and the responsibility of the physician.
Disclosure of Interest
None Declared |
| first_indexed | 2024-03-11T07:42:40Z |
| format | Article |
| id | doaj.art-e8d85e11446d435da4cc166dfc12fdd2 |
| institution | Directory Open Access Journal |
| issn | 0924-9338 1778-3585 |
| language | English |
| last_indexed | 2024-03-11T07:42:40Z |
| publishDate | 2023-03-01 |
| publisher | Cambridge University Press |
| record_format | Article |
| series | European Psychiatry |
| spelling | doaj.art-e8d85e11446d435da4cc166dfc12fdd22023-11-17T05:08:23ZengCambridge University PressEuropean Psychiatry0924-93381778-35852023-03-0166S882S88210.1192/j.eurpsy.2023.1867Fatal pulmonary embolism related to anti-psychotics: forensic implications. About four autopsy cases with review of the literatureM. Kacem0W. Bouali1Y. Mahjoub2S. Brahim3L. Zarrouk4Psychiatric department, Taher Sfar Hospital of Mahdia, Mahdia, TunisiaPsychiatric department, Taher Sfar Hospital of Mahdia, Mahdia, TunisiaPsychiatric department, Taher Sfar Hospital of Mahdia, Mahdia, TunisiaPsychiatric department, Taher Sfar Hospital of Mahdia, Mahdia, TunisiaPsychiatric department, Taher Sfar Hospital of Mahdia, Mahdia, Tunisia Introduction The association between the intake of antipsychotic drugs and the occurrence of thromboembolic complications is widely described in the literature. The occurrence of this complication may call into question the medical responsibility of the attending physician. Objectives The objective of this work is to describe the physiopathological mechanisms involved in the occurrence of thromboembolic complications in a patient under antipsychotic treatment, whether or not associated with physical restraint and to discuss the forensic implications. Methods Our study is retrospective on cases of fatal pulmonary embolism, discovered at autopsy, in connection with the taking of antipsychotics. The autopsies were carried out in the Department of Forensic Medicine of the Tahar Sfar University Hospital in Mahdia. The cases were collected over a period of 04 years. A review of the literature was carried out. We only selected articles published until February 2021 and dealing with cases of patients on antipsychotics, diagnosed with pulmonary embolism by performing a chest CT scan or during an autopsy. Results 915 autopsy cases were performed during the study period. Twenty cases of pulmonary embolism, discovered at autopsy, were collected. Four cases were related to the taking of antipsychotics (incidence 0.004%), including two men and two women, aged between 25 and 52 years. They were all on antipsychotic treatment for at least 5 years, with the exception of one case who was put on 3 antipsychotics, 7 days before his death, with indication of physical restraint. After analysis of the memorial data, the external examination and the autopsy, the results of additional examinations, the death was attributed, in the 4 cases, to a massive fibrino-cruoric pulmonary embolism. A selection of 45 studies regarding thromboembolic complications associated with taking antipsychotics, was included in the final review. Conclusions The reported cases provided additional evidence on the involvement of antipsychotics in the occurrence of thromboembolic complications. Psychiatrists should be careful when prescribing these treatments. The establishment of therapeutic guidelines, taking into account the thromboembolic risk factors, becomes essential, in order to avoid the occurrence of a complication which could engage both the vital prognosis of patients and the responsibility of the physician. Disclosure of Interest None Declaredhttps://www.cambridge.org/core/product/identifier/S0924933823018679/type/journal_article |
| spellingShingle | M. Kacem W. Bouali Y. Mahjoub S. Brahim L. Zarrouk Fatal pulmonary embolism related to anti-psychotics: forensic implications. About four autopsy cases with review of the literature European Psychiatry |
| title | Fatal pulmonary embolism related to anti-psychotics: forensic implications. About four autopsy cases with review of the literature |
| title_full | Fatal pulmonary embolism related to anti-psychotics: forensic implications. About four autopsy cases with review of the literature |
| title_fullStr | Fatal pulmonary embolism related to anti-psychotics: forensic implications. About four autopsy cases with review of the literature |
| title_full_unstemmed | Fatal pulmonary embolism related to anti-psychotics: forensic implications. About four autopsy cases with review of the literature |
| title_short | Fatal pulmonary embolism related to anti-psychotics: forensic implications. About four autopsy cases with review of the literature |
| title_sort | fatal pulmonary embolism related to anti psychotics forensic implications about four autopsy cases with review of the literature |
| url | https://www.cambridge.org/core/product/identifier/S0924933823018679/type/journal_article |
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