Pulmonary embolism induced by clozapine: report of 3 cases
10.3760/cma.j.cn114015-20190731-00625
- VernacularTitle:氯氮平致肺栓塞3例
- Author:
Xiangli CUI
1
;
Heng GUO
1
;
Xiaojian WANG
1
;
Weina WANG
1
;
Su SHEN
1
Author Information
1. 首都医科大学附属北京友谊医院药学部 100050
- Publication Type:Journal Article
- Keywords:
Clozapine;
Thrombosis;
Pulmonary embolism
- From:
Adverse Drug Reactions Journal
2020;22(9):545-547
- CountryChina
- Language:Chinese
-
Abstract:
Three patients (patient 1, a 48-years-old male; patient 2, a 65-years-old female; patient 3, a 58-years-old female) received clozapine for schizophrenia at daily doses of 200 mg, 175 mg, and 100 mg, respectively. Patient 1 developed venous thrombosis of lower limbs after 16 years of clozapine treatment, which was improved after thrombolytic therapy. Ten years later, the patient developed shortness of breath after activity and the symptom gradually worsened. Bilateral pulmonary embolism was diagnosed by computed tomographic pulmonary angiography (CTPA), and warfarin and rivaroxaban were given successively for anticoagulation. One year later, the patient developed cardiac insufficiency. The patient was diagnosed as having chronic thromboembolic pulmonary hypertension (pulmonary artery systolic pressure was 86 mmHg), chronic cor pulmonale, and cardiac insufficiency. Warfarin combined with cardiac glycosides, diuretics, and other symptomatic treatments were given. After 3 months of treatments, his dyspnea was markedly relieved and the pulmonary systolic pressure was reduced to 48 mmHg. Patient 2 developed pulmonary embolism after 5 years of clozapine treatment. After thrombolytic therapy, he was given oral warfarin and the drug was discontinued by himself 3 years later. Pulmonary embolism recurred 2 years after the drug withdrawal. Nadroparin calcium and warfarin anticoagulation was given successively and 3 months later, CTPA showed that pulmonary embolism basically disappeared. Patient 3 developed lower-extremity venous thrombosis after 2 years of clozapine treatment, and pulmonary embolism occurred 1 year later, which was improved after anticoagulation, diuretics, and other treatments. Three years later, the patient stopped warfarin by herself, and 10 months later, her pulmonary embolism recurred. Low-molecular-weight heparin sodium as bridge therapy to warfarin was given. Three months later, CTPA showed that pulmonary artery thrombosis basically disappeared.
