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• W3093442849 abstract "SESSION TITLE: Medical Student/Resident Pulmonary Vascular Disease Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Chronic thromboembolic pulmonary hypertension (CTEPH) is a condition characterized by persistent thromboemboli in the pulmonary arteries (PA). CTEPH is seen in 2-4% of patients with acute pulmonary embolism (PE) 1. Multiple risk factors have been identified, but little is known about possible association between CTEPH and Psychiatric Disorders (PD) patients, especially schizophrenia. CASE PRESENTATION: The patient is a 57 y/o obese (BMI 35) AA woman with a PMH of Schizophrenia and recurrent PE, complicated by Pulmonary Hypertension. She had 5 admissions in 3 years with the diagnosis of PE., most recent in March ’20. Chest Angiogram (CTA) showed a large thromboembolism within the right PA, and features of acute on chronic emboli bilaterally. In addition, the CTA revealed chronic extensive bilateral emboli and right ventricular (RV) strain. Previous images were all consistent with these findings. Bilateral venous doppler studies were negative for thrombosis. Echocardiogram showed moderately dilated RV, and elevated pulmonary artery pressure (PAP) with an estimated peak of 55-60 mmHg. During each admission, the patient was treated with therapeutic anticoagulation with transition to Rivaroxaban prior to discharge. In the outpatient setting, she was followed by subspecialists in Pulmonology, Hematology, and Psychiatry along with her Primary care physician. Her medications did not include any hormonal treatment. She has no past or present history of autoimmune disease, trauma, travel or immobilization, and patient’s work up for malignancy and thrombophilia were negative. There is no FH of VTE. In addition to her hospital admissions for PE, she also had multiple admissions to Inpatient Psych for Acute Psychosis. Currently, her medications include Quetiapine 400 mg tablet daily and Aripiprazole injections 3.9 ml (1,064) every 60 days, in addition to amlodipine 10 mg and Rivaroxaban 20 mg. She has intermittent medication non-compliance due to insurance issues. DISCUSSION: Evidence shows that recurrent PE and CTEPH are more common in patients with PD than in the general population 2,3. There is further evidence that Psychosis might contribute to thrombus formation 3,4. Schizophrenia typically precedes CTEPH. It's proposed that PD itself and/or antipsychotics increase stress hormones, along with thrombogenic mediators, and change platelet serotonin metabolism, thus propagating thrombosis. Other explanations include the interference of PE thrombolysis and anticoagulation by the schizophrenia and/or antipsychotics, thereby promoting CTEPH 3,4. Moreover, it has been reported that among CTEPH patients, those with PD have poorer prognoses 5. CONCLUSIONS: Although not yet fully understood, there should be a low threshold for considering prophylactic antithrombotic therapy in PDs patients on antipsychotics 3. More research is needed and anticipated. Reference #1: (1)Meng Zhang, Ning Wang, Zhenguo Zhai, et al, Incidence and risk factors of chronic thromboembolic pulmonary hypertension after acute pulmonary embolism: a systematic review and meta-analysis of cohort studies, J Thorac Dis 2018;10(8):4751-4763 http://dx.doi.org/10.21037/jtd.2018.07.106 Reference #2: (2)Amy Barnhorst, Glen L. Xiong, Pulmonary Embolism in a Psychiatric Patient, Am J Psychiatry 171:11, November 2014 (doi: 10.1176/appi.ajp.2013.13040494). Reference #3: (3)Anna K. Jo¨nsson, Johan Schill, Hans Olsson, Olav Spigset, Staffan Ha¨gg, Venous Thromboembolism During Treatment with Antipsychotics: A Review of Current Evidence, CNS Drugs (2018) 32:47–64, https://doi.org/10.1007/s40263-018-0495-7 DISCLOSURES: No relevant relationships by Helen Kornblum, source=Web Response No relevant relationships by Mohamed Maali Mohamed, source=Web Response No relevant relationships by Dani Tazbaz, source=Web Response" @default.
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• W3093442849 date "2020-10-01" @default.
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• W3093442849 title "CHRONIC THROMBOEMBOLIC PULMONARY HYPERTENSION AND SCHIZOPHRENIA" @default.
• W3093442849 doi "https://doi.org/10.1016/j.chest.2020.08.1830" @default.
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