Below is the abstract of the manuscript that summarizes the findings:
Backgroud: We estimated stroke risk associated with new exposure to any typical antipsychotic, or, haloperidol vs. atypical antipsychotics among patients aged 18-64 years without dementia and, separately, regardless of dementia diagnosis.
Methods: Data were obtained from IBM MarketScan® Commercial Database (CCAE, 01 January 2001 - 31 December 2017). Among those without a recent dementia diagnosis, stroke risk for new users of typical antipsychotics (T1 cohort) or haloperidol (T2 cohort) was compared with new users of atypical antipsychotics (C1 cohort). A similar comparison was conducted for new users of typical antipsychotics (T3 cohort) or haloperidol (T4 cohort) vs. new users of atypical antipsychotics (C2 cohort), regardless of recent dementia diagnosis. Crude incident stroke rates (cIRs) within each cohort were calculated. For each comparison three hazard ratios (HRs) were reported, two of which were adjusted using propensity score (PS) matching strategies to limit confounding: unadjusted (crude), Sentinel PS strategy, and large-scale regularized regression model (adapted PS strategy).
Results: Each cohort included ≥12,000 patients. The cIRs for stroke per 1,000 person-years were 3.10 (T1), 5.99 (T2), 3.14 (T3), 6.12 (T4), 0.85 (C1), and 0.90 (C2). Pre-planned analysis with adapted PS strategy matching yielded calibrated HRs (cHRs) for stroke: T1 vs. C1: 2.05 (calibrated confidence interval=1.13-3.89); T2 vs. C1: 2.47 (1.14-5.48), T3 vs. C2: 1.64 (0.94-2.97), T4 vs. C2: 1.98 (0.99-4.00). A post-hoc sensitivity analysis to address possible confounding introduced by the 2015 change from ICD-9 to ICD-10 yielded cHRs for T1 vs. C1: 1.59 (0.87-3.01); T2 vs. C1: 2.79 (1.24-6.42), T3 vs. C2: 1.41 (0.79-2.62), T4 vs. C2: 3.47 (1.63-7.92).
Conclusion: For both the pre-planned and sensitivity analysis, relative to users of atypical antipsychotics, risk of stroke among non-elderly patients without a recent dementia diagnosis was not higher among users of all typical antipsychotics, but was higher among users of haloperidol. Though it was narrowly missed for haloperidol for non-elderly patients regardless of dementia status, no statistically significant difference in stroke risk was observed among non-elderly users of all typical antipsychotics or of haloperidol.
Below are links for study-related artifacts that have been made available as part of this study: