Is Haloperidol Safe for Delirium in MI?

The use of haloperidol instead of atypical antipsychotics for delirium in patients hospitalized for myocardial infarction (MI) may result in a slightly higher risk of death, according to a new study.

Researchers arrived at this conclusion following a study of 6578 hospitalized MI patients older than age 18 years who were treated with either oral haloperidol (n = 1668) or an oral atypical antipsychotic (n = 4910), such as olanzapine, quetiapine, or risperidone.
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Study findings indicated that, although mean treatment duration was shorter in patients using haloperidol vs atypical antipsychotics (2.4 vs 3.9 days), the risk of death over 7-day follow-up was higher with haloperidol use compared with atypical antipsychotic use (129 vs 92 deaths).

The absolute rates of death were 1.7 and 1.1 per 100 person-days for haloperidol and atypical antipsychotics, respectively.

The researchers noted that this association was strongest during the first 4 days of follow-up and waned over time, with no evident risk observed by day 5. The unadjusted and adjusted hazard ratios were 1.90 and 1.93, respectively, in the as-treated analyses.

“The results suggest a small increased risk of death within seven days of initiating haloperidol compared with initiating an atypical antipsychotic in patients with acute myocardial infarction,” the researchers concluded. “Although residual confounding cannot be excluded, this finding deserves consideration when haloperidol is used for patients admitted to hospital with cardiac morbidity.”

—Christina Vogt

Reference:

Park Y, Bateman BT, Kim DH, et al. Use of haloperidol versus atypical antipsychotics and risk of in-hospital death in patients with acute myocardial infarction: cohort study [Published online March 28, 2018]. BMJ. https://doi.org/10.1136/bmj.k1218.