Korean Journal of Psychosomatic Medicine (정신신체의학)

Korean Psychosomatic Society (한국정신신체의학회)
권호 표지
DOI QR코드

DOI QR Code

A Retrospective Study on the Effect of 1-Year Clozapine Administration on Platelet Activity in Patients with Schizophrenia or Schizoaffective Disorder

조현병/조현정동장애 환자에서 1년간의 Clozapine 투여가 혈소판 활성도에 미치는 영향에 관한 후향적 연구

  • Jang, EunJa (Department of Psychiatry, College of Medicine, Konyang University) ;
  • Lee, Jong Wook (Konyang University Myunggok Medical Research Institute) ;
  • Kim, Seung-Jun (Department of Psychiatry, College of Medicine, Konyang University) ;
  • Oh, Hong-Seok (Department of Psychiatry, College of Medicine, Konyang University) ;
  • Im, Woo Young (Department of Psychiatry, College of Medicine, Konyang University) ;
  • Lee, Na-Hyun (Department of Psychiatry, College of Medicine, Konyang University) ;
  • Kim, Ji-Woong (Department of Psychiatry, College of Medicine, Konyang University)
  • 장은자 (건양대학교 의과대학 정신건강의학과교실) ;
  • 이종욱 (건양대학교 명곡의과학연구소) ;
  • 김승준 (건양대학교 의과대학 정신건강의학과교실) ;
  • 오홍석 (건양대학교 의과대학 정신건강의학과교실) ;
  • 이나현 (건양대학교 의과대학 정신건강의학과교실) ;
  • 임우영 (건양대학교 의과대학 정신건강의학과교실) ;
  • 김지웅 (건양대학교 의과대학 정신건강의학과교실)
  • Received : 2020.04.02
  • Accepted : 2020.05.16
  • Published : 2020.06.30
Download PDF
⟨ Previous Next ⟩

Abstract

Objectives : Clozapine has been known to increase the possibility of developing cardio/cerebrovascular diseases, and the platelet activation has been deemed to be related to the occurrence of them. In author's previous study, we observed the increase of platelet activity with short-term clozapine administration. This study was conducted, as a follow-up study, to investigate the effect of clozapine on the platelet activity when administered continuously for long-term period of time of 1 year. Methods : The medical records of the patients with schizophrenia or schizoaffective disorder who were treated with clozapine for 1 year were retrospectively reviewed. The degree of platelet activation was assessed by measuring the mean platelet component. Results : Total of 24 patients were enrolled. 9 of them (37.5%) were male and 15 of them (62.5%) were female. In the Wilcoxon sign-ranks test, no significant change was observed between the mean platelet factor values at the beginning and at the end of one year. Conclusions : No significant changes of mean platelet activity were observed after continued administration of clozapine for 1 year. Considering the author's previous findings that observed a prominent decrease of mean platelet component after short-term clozapine administration, the result of this study suggests the possibility that the activity of the platelet may change depending on the duration of the clozapine administration.

연구목적 클로자핀은 뇌심혈관 질환의 발생가능성을 높이는 것으로 알려져 있으며, 혈소판의 활성화 정도는 뇌심혈관 질환의 발생과 관련이 있을 것으로 생각되어왔다. 저자들은 이전 연구에서 단기간의 클로자핀 투여 후 혈소판 활성도가 증가함을 관찰하였다. 본 연구는 이에 대한 후속 연구로 클로자핀을 1년의 기간 동안 장기간 지속 투여하였을 때, 혈소판 활성도에 어떤 영향을 미치는지를 알아보기 위해 시행하였다. 방 법 조현병 혹은 조현정동장애의 치료를 위해 최소 1년의 기간 동안 지속적으로 클로자핀을 투여 받은 환자들의 의무기록을 후향적으로 검토하였다. 혈소판의 활성도는 평균혈소판요소 값을 이용하여 측정하였다. 결 과 총 24명의 환자를 대상으로 하였고, 연구 대상자 중 남성은 9명(37.5%), 여성은 15명(62.5%) 였다. 윌콕슨부호-순위검정에서 초기 및 1년 경과 시점에서의 평균혈소판요소 값 사이의 유의한 변화는 관찰되지 않았다. 결 론 1년간의 지속적인 클로자핀 투여에도 평균혈소판요소의 유의한 변화가 관찰되지 않았다. 단기간의 클로자핀 투여 시 평균혈소판요소 값에 현저한 저하를 관찰하였던 저자들의 이전의 연구 결과를 함께 고려해 볼 때, 본 연구의 결과는 클로자핀 투여 기간에 따라 혈소판의 활성도가 변화할 가능성을 시사한다.

Keywords

References

  1. Kasckow J, Felmet K, Zisook S. Managing suicide risk in patients with schizophrenia. CNS Drugs 2011;25:129-143 https://doi.org/10.2165/11586450-000000000-00000
  2. Masopust J, Maly R, Valis M. Risk of venous thromboembolism during treatment with antipsychotic agents. Psychiatry Clin Neurosci 2012;66:541-552. https://doi.org/10.1111/pcn.12001
  3. Lund BC, Perry PJ, Brooks JM, Arndt S. Clozapine use in patients with schizophrenia and the risk of diabetes, hyperlipidemia, and hypertension: a claims-based approach. Arch Gen Psychiatry 2001;58:1172-1176. https://doi.org/10.1001/archpsyc.58.12.1172
  4. Poudyal R, Lohani S. Clozapine associated pulmonary embolism: systematic review. J Community Hosp Intern Med Perspect 2019;9:300-304. https://doi.org/10.1080/20009666.2019.1627848
  5. Parker C, Coupland C, Hippisley-Cox J. Antipsychotic drugs and risk of venous thromboembolism: nested case-control study. BMJ 2010;341:c4245. https://doi.org/10.1136/bmj.c4245
  6. Kim HA, Lee JW, Kim SJ, Oh HS, Im WY, Kim JW. Second-generation antipsychotics activate platelets in antipsychotic-naive and antipsychotic-free patients with schizophrenia: a retrospective study. Int J Psychiatry Med 2020;55:105-113. https://doi.org/10.1177/0091217419874277
  7. Chapman ES, Sorette M, Hetherington E, Zelmanovic D, Dugailliez J, Pujol-Moix N, Okrongly D. A rapid, automated flow cytometric method to measure activated degranulated platelets by density determination. Thromb Haemost 2003;89:1004-1015. https://doi.org/10.1267/THRO03061004
  8. Macey MG, Carty E, Webb L, Champman ES, Zelmanovic D, Rampton DS, Newland AC. Use of mean platelet component to measure platelet activation on the ADVIA 120 haematology system. Cytometry 1999;38:250-255. https://doi.org/10.1002/(SICI)1097-0320(19991015)38:5<250::AID-CYTO8>3.0.CO;2-K
  9. Lee J, Takeuchi H, Fervaha G, Powell V, Bhaloo A, Bies R, Remington G. The effect of clozapine on hematological indices: a 1-year follow-up study. J Clin Psychopharmacol 2015;35:510-516. https://doi.org/10.1097/JCP.0000000000000387
  10. Sarvaiya N, Lapitskaya Y, Dima L, Manu P. Clozapine-associated pulmonary embolism: a high-mortality, dose-independent and early-onset adverse effect. Am J Ther 2018;25:e434-e438. https://doi.org/10.1097/MJT.0000000000000806
  11. Leysen JE, de Chaffoy de Courcelles D, De Clerck F, Niemegeers CJ, Van Nueten JM. Serotonin-S2 receptor binding sites and functional correlates. Neuropharmacology 1984;23:1493-1501. https://doi.org/10.1016/0028-3908(84)90093-5
  12. Dietrich-Muszalska A, Wachowicz B. Platelet haemostatic function in psychiatric disorders: effects of antidepressants and antipsychotic drugs. World J Biol Psychiatry 2017;18:564-574. https://doi.org/10.3109/15622975.2016.1155748
  13. Zahorodna A, Bobula B, Grzegorzewska M, Tokarski K, Hess G. The influence of repeated administration of clozapine and haloperidol on the effects of the activation of 5-HT(1A), 5-HT(2) and 5-HT(4) receptors in rat frontal cortex. J Physiol Pharmacol 2004;55:371-379.
  14. Bae SH, Lee J, Roh KH, Kim J. Platelet activation in patients with diabetic retinopathy. Korean J Ophthalmol 2003;17:140-144. https://doi.org/10.3341/kjo.2003.17.2.140
  15. Sertbas Y, Sertbas M, Okuroglu N, Ozturk MA, Abacar KY, Ozdemir A. Mean platelet volume changes before and after glycated hemoglobin (HbA1c) improvement in a large study population. Arch Med Sci 2017;13:711-715.
  16. Agrawal J, Singh VB, Meena B, Yadav R, Shareef M, Saini V. Mean platelet volume (MPV) the neglected marker of cardiovascular risk and glycosylated hemoglobin in diabetic patient. Diabetes Metab Syndr 2017;11:109-112. https://doi.org/10.1016/j.dsx.2016.08.014
  17. Chu SG, Becker RC, Berger PB, Bhatt DL, Eikelboom JW, Konkle B, Mohler ER, Reilly MP, Berger JS. Mean platelet volume as a predictor of cardiovascular risk: a systematic review and meta-analysis. J Thromb Haemost 2010;8:148-156. https://doi.org/10.1111/j.1538-7836.2009.03584.x