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Sudden Cardiac and Sudden Unexpected Death Related to Antipsychotics: A Meta-analysis of Observational Studies

Lookup NU author(s): Professor Simon Thomas



This is the authors' accepted manuscript of an article that has been published in its final definitive form by Wiley-Blackwell Publishing Ltd., 2016.

For re-use rights please refer to the publisher's terms and conditions.


To estimate the risk of sudden cardiac death (SCD) or sudden unexpected death (SUD) related to individual antipsychotics, a meta-analysis of observational studies was performed. Adjusted odds ratio (OR) of SCD/SUD with 95% confidence intervals (CI) were extracted and pooled; heterogeneity was studied using Q statistic and I-2 index, and its potential causes (e.g., hERG blockade potency) explored using meta-regression. Two cohort (740,306 person-years) and four case-control (2,557 cases; 17,670 controls) studies, investigating nine antipsychotics, were included. Compared with nonusers, the risk was increased for quetiapine (OR = 1.72, 95% CI: 1.33-2.23), olanzapine (OR = 2.04, 1.52-2.74), risperidone (OR = 3.04, 2.39-3.86), haloperidol (OR = 2.97, 1.59-5.54), clozapine (OR = 3.67, 1.94-6.94), and thioridazine (OR = 4.58, 2.09-10.05). Heterogeneity was found (Q = 20.0, P = 0.01; I-2 = 60.0%), and the increasing mean hERG blockade potency (P = 0.01) accounted for 43% of this. The SCD/SUD risk differed between individual antipsychotics, and mean hERG blockade potency could be an explanatory factor. This should be considered when initiating antipsychotic treatment.

Publication metadata

Author(s): Salvo F, Pariente A, Shakir S, Robinson P, Arnaud M, Thomas SHL, Raschi E, Fourrier-Reglat A, Moore N, Sturkenboom M, Hazell L, Investigators Aritmo Consortium

Publication type: Article

Publication status: Published

Journal: Clinical Pharmacology & Therapeutics

Year: 2016

Volume: 99

Issue: 3

Pages: 306-314

Print publication date: 01/03/2016

Online publication date: 20/11/2015

Acceptance date: 09/08/2015

Date deposited: 03/06/2016

ISSN (print): 0009-9236

ISSN (electronic): 1532-6535

Publisher: Wiley-Blackwell Publishing Ltd.


DOI: 10.1002/cpt.250


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