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Objective Mounting evidence suggests that antipsychotics may have immunomodulatory effects, but their impact on disseminated infections remains unknown. This study thus sought to estimate the effect of antipsychotic treatment on the occurrence of bloodstream infection during long-term follow-up in adult patients with chronic obstructive pulmonary disease. Methods This retrospective cohort study, with new user and active comparator design, included adult patients seen from January 2008 to June 2018 in a tertiary teaching hospital in Buenos Aires, Argentina. New users of antipsychotic drugs were compared to new users of any benzodiazepine. The primary outcome of interest was incident bloodstream infection at 1 year of follow-up. Propensity score methods and a Cox proportional hazards model were used to adjust for baseline confounding. Results A total of 923 patients were included in the present analysis. Mean (SD) age was 75.0 (9.8) years, and 51.9% of patients were female. The cumulative incidence of bloodstream infections at 1 year was 6.0% and 2.3% in the antipsychotic and benzodiazepine groups, respectively. Antipsychotic use was associated with a higher risk of bloodstream infections during the first year of follow-up (hazard ratio [HR] = 2.41; 95% CI, 1.13 to 5.14) compared to benzodiazepine use. Antipsychotics with high dopamine receptor affinity presented greater risk than less selective agents (HR = 5.20; 95% CI, 1.53 to 17.67). Conclusions Antipsychotic use is associated with bloodstream infections during the first year of follow-up in adult patients with chronic obstructive pulmonary disease. Further studies are warranted to confirm our findings and evaluate this effect in a broader population of patients.

Background Venous thromboembolism (VTE) represents a major cause of morbidity and mortality worldwide. Antipsychotic treatment is associated with an increased risk of thromboembolic disease, an effect that seems to be constant across the spectrum of distinct agents. This study sought to delineate the effect of new antipsychotic use on the risk of recurrent thromboembolic events after a first episode of either deep venous thrombosis or pulmonary embolism. Methods This cohort study, conducted between January 2010 and June 2017, was based on a prospectively collected database of adult patients with VTE. The main exposure was the new onset of antipsychotic treatment after having a first episode of venous thromboembolic disease. The primary outcome was defined as recurrent VTE, either deep venous thrombosis or pulmonary embolism, during long-term follow-up. The composite of all-cause mortality and recurrent VTE served as the secondary outcome. An inverse probability weighted multivariable Cox proportional hazards model was fitted to adjust for measured confounding and competing risks. Results One thousand one hundred three patients were included in the present analysis, of whom 136 were identified as new users of antipsychotic agents. A total of 67% of patients were currently treated with full-dose anticoagulation at baseline. No association was found between the new use of antipsychotic agents and recurrent VTE during follow-up (adjusted hazard ratio (HR) = 1.08; 95% CI, 0.38-3.08). However, the use of these agents was associated with a 63% increased risk of recurrent VTE or all-cause mortality (adjusted HR = 1.63; 95% CI, 1.26-2.10). Conclusions The use of antipsychotic agents among patients with a first episode of VTE and full-dose anticoagulation was not associated with an increased risk of recurrent thromboembolic events. However, antipsychotic treatment was associated with a higher risk of both VTE and all-cause mortality. Further studies are warranted to confirm these findings.