BMJ  2005;330:445 (26 February), doi:10.1136/bmj.38330.470486.8F (published 24 January 2005)

Paper

Atypical antipsychotic drugs and risk of ischaemic stroke: population based retrospective cohort study

Sudeep S Gill, adjunct scientist1, Paula A Rochon, assistant director2, Nathan Herrmann, head3, Philip E Lee, geriatrician6, Kathy Sykora, senior biostatistician1, Nadia Gunraj, biostatistician1, Sharon-Lise T Normand, professor of biostatistics7, Jerry H Gurwitz, professor8, Connie Marras, neurologist4, Walter P Wodchis, scientist5, Muhammad Mamdani, scientist1

1 Institute for Clinical Evaluative Sciences, 2075 Bayview Avenue, Toronto, ON, Canada, 2 Kunin-Lunenfeld Applied Research Unit, Baycrest Centre for Geriatric Care, Toronto, 3 Division of Geriatric Psychiatry, Department of Psychiatry, Sunnybrook and Women's College Health Sciences Centre, Toronto, 4 Morton and Gloria Shulman Movement Disorders Centre, Toronto Western Hospital, Toronto, 5 Toronto Rehabilitation Institute, Toronto, 6 Division of Geriatric Medicine, University of British Columbia, Vancouver, BC, Canada, 7 Department of Health Care Policy, Harvard Medical School and Harvard School of Public Health, Boston, MA, USA, 8 Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester, MA

Correspondence to: S S Gill, Room 1-152, Chapel Wing, St Mary's of the Lake Hospital, 340 Union Street, Kingston, ON, Canada K7L 5A2 gills{at}pccchealth.org

Objective To compare the incidence of admissions to hospital for stroke among older adults with dementia receiving atypical or typical antipsychotics.

Design Population based retrospective cohort study.

Setting Ontario, Canada.

Patients 32 710 older adults (≤ 65 years) with dementia (17 845 dispensed an atypical antipsychotic and 14 865 dispensed a typical antipsychotic).

Main outcome measures Admission to hospital with the most responsible diagnosis (single most important condition responsible for the patient's admission) of ischaemic stroke. Observation of patients until they were either admitted to hospital with ischaemic stroke, stopped taking antipsychotics, died, or the study ended.

Results After adjustment for potential confounders, participants receiving atypical antipsychotics showed no significant increase in risk of ischaemic stroke compared with those receiving typical antipsychotics (adjusted hazard ratio 1.01, 95% confidence interval 0.81 to 1.26). This finding was consistent in a series of subgroup analyses, including ones of individual atypical antipsychotic drugs (risperidone, olanzapine, and quetiapine) and selected subpopulations of the main cohorts.

Conclusion Older adults with dementia who take atypical antipsychotics have a similar risk of ischaemic stroke to those taking typical antipsychotics.


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Rapid Responses:

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Since when has observation trumped the RCT?
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