[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"doc-seo-453482-105":3,"detail-sidebar-cat-0-en-105":81,"doc-detail-453482-en":131},{"code":4,"msg":5,"data":6},0,"ok",{"site_id":7,"language":8,"slug":9,"title":10,"keywords":11,"description":12,"schema_data":13,"social_meta":74,"head_meta":76,"extra_data":78,"updated_unix":80},105,"en","clozapine-associated-pulmonary-embolism-continuation-of-clozapine-therapy-with-concurrent-anticoagulation","Clozapine-Associated Pulmonary Embolism - Continuation of Clozapine Therapy With Concurrent Anticoagulation","","Clozapine, a gold-standard treatment for treatment-resistant schizophrenia, can trigger adverse effects, including rare but severe pulmonary embolism (PE), yet clear guidance on preventive anticoagulation remains limited. A case is presented of a male in his late 30s with schizophrenia who developed recurrent thromboembolic events while on clozapine. Despite a second PE occurrence, clozapine was continued successfully together with concurrent anticoagulation, supporting individualized management. The report emphasizes an evidence gap in prevention strategies for patients receiving clozapine.",{"@graph":14,"@context":73},[15,34,56],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/document/","Document",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/document/healthcare/","Healthcare",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/document/clozapine-associated-pulmonary-embolism-continuation-of-clozapine-therapy-with-concurrent-anticoagulation/453482/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/clozapine-associated-pulmonary-embolism-continuation-of-clozapine-therapy-with-concurrent-anticoagulation/453482.png","ImageObject",300,407,{"name":42,"@type":43},"Theodore","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/pdf","2026-10-30","2026-09-30",true,{"@type":52,"interactionType":53,"userInteractionCount":55},"InteractionCounter",{"@type":54},"ViewAction",16,{"@type":57,"mainEntity":58},"FAQPage",[59,65,69],{"name":60,"@type":61,"acceptedAnswer":62},"Why is clozapine considered a gold standard in this case report?","Question",{"text":63,"@type":64},"Clozapine is considered the gold standard when first-line antipsychotic treatments are ineffective due to its superior efficacy in reducing psychotic symptoms.","Answer",{"name":66,"@type":61,"acceptedAnswer":67},"What thromboembolic complication developed during clozapine therapy?",{"text":68,"@type":64},"The patient developed recurrent thromboembolic events, including deep vein thrombosis (DVT) and a second pulmonary embolism (PE) during clozapine treatment.",{"name":70,"@type":61,"acceptedAnswer":71},"How was clozapine managed after pulmonary embolism occurred?",{"text":72,"@type":64},"Even after the second PE, clozapine therapy was continued successfully while using concurrent anticoagulation, guided by individualized assessment.","https://schema.org",{"og:url":32,"og:type":75,"og:title":10,"og:site_name":45,"og:description":12},"article",{"robots":77,"canonical":32},"index,follow",{"doc_id":79,"site_id":7},453482,1790794344,{"code":4,"msg":82,"data":83},"success",[84,88,92,96,101,106,110,115,120,123,127],{"id":22,"doc_module":4,"doc_module_name":25,"category_name":85,"show_sort_weight":86,"slug":87},"Story & Novel",90,"story-novel",{"id":26,"doc_module":4,"doc_module_name":25,"category_name":89,"show_sort_weight":90,"slug":91},"Literature",80,"literature",{"id":33,"doc_module":4,"doc_module_name":25,"category_name":93,"show_sort_weight":94,"slug":95},"Exam",70,"exam",{"id":97,"doc_module":4,"doc_module_name":25,"category_name":98,"show_sort_weight":99,"slug":100},5,"Comic",60,"comic",{"id":102,"doc_module":4,"doc_module_name":25,"category_name":103,"show_sort_weight":104,"slug":105},6,"Technology",50,"technology",{"id":107,"doc_module":4,"doc_module_name":25,"category_name":29,"show_sort_weight":108,"slug":109},7,40,"healthcare",{"id":111,"doc_module":4,"doc_module_name":25,"category_name":112,"show_sort_weight":113,"slug":114},8,"Research & Report",30,"research-report",{"id":116,"doc_module":4,"doc_module_name":25,"category_name":117,"show_sort_weight":118,"slug":119},9,"Religion & Spirituality",20,"religion-spirituality",{"id":118,"doc_module":4,"doc_module_name":25,"category_name":121,"show_sort_weight":118,"slug":122},"World Cup","world-cup",{"id":124,"doc_module":4,"doc_module_name":25,"category_name":125,"show_sort_weight":124,"slug":126},10,"Lifestyle","lifestyle",{"id":128,"doc_module":4,"doc_module_name":25,"category_name":129,"show_sort_weight":97,"slug":130},19,"General","general",{"code":4,"msg":82,"data":132},{"doc_id":79,"user_id":133,"nickname":42,"user_avatar":134,"doc_module":4,"category_id":107,"category_name":29,"doc_title":10,"doc_description":12,"doc_content":135,"file_id":136,"file_url":137,"file_type":138,"file_size":139,"view_count":55,"is_deleted":4,"is_public":22,"is_downloadable":22,"audit_status":22,"page_count":33,"language":140,"language_code":8,"site_id":7,"html_lang":8,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":12,"update_tm":144,"read_time":124,"preview_page_count":4},7971461740886,"https://ap-avatar.wpscdn.com/davatar_3d24733baf745e90a7e4bdd5f77d97b2","Wiley  \nCase Reports in Psychiatry  \nVolume 2026, Article ID 6686502, 4 pages [https://doi.org/10.1155/crps/6686502](https://doi.org/10.1155/crps/6686502)  \nCase Report  \nClozapine-Associated Pulmonary Embolism: Continuation of Clozapine Therapy With Concurrent Anticoagulation  \nM. R. Jahangir, 1 C. Heerema, 1 J. Biedermann,2 S. Dieleman , 1 and  \nN. H. Grootendorst-van Mil 1  \n1Department of Psychiatry, Erasmus MC, University Medical Center Rotterdam, P. O. Box 2040, 3000 CA, Rotterdam, Netherlands 2Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, P. O. Box 2040, 3000 CA, Rotterdam, Netherlands  \nCorrespondence should be addressed to N. H. Grootendorst-van Mil; [n.grootendorst@erasmusmc.nl](n.grootendorst@erasmusmc.nl)  \nReceived 23 July 2025; Revised 26 November 2025; Accepted 22 December 2025  \nAcademic Editor: Philipp Sand  \nCopyright © 2026 M. R. Jahangir et al. Case Reports in Psychiatry published by John Wiley & Sons Ltd. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.  \nClozapine, a gold standard for treatment-resistant schizophrenia, is associated with a range of adverse effects, including the rare but serious risk of pulmonary embolism (PE) . The management of such complications, particularly in the absence of clear guidelines for preventive anticoagulation, poses significant challenges. We present a case of a male (in his late 30s) with schizophrenia who developed recurrent thromboembolic events during clozapine therapy. Despite the occurrence of a second PE, clozapine therapy was continued successfully with concurrent anticoagulation. This case highlights the need for individualized treatment strategies and underscores the critical gap in evidence regarding preventive anticoagulation in patients with clozapine.  \nKeywords: anticoagulation; clozapine; pulmonary embolism  \n1. Introduction  \nWhen first-line antipsychotic treatments prove ineffective, clozapine is considered the gold standard treatment for psychotic disorders due to its superior efficacy in reducing psychotic symptoms. However, clozapine use is associated with various adverse effects, including the rare but serious risk of pulmonary embolism (PE) . The evidence for preventive anticoagulation inpatients on clozapine is limited, making management of this complication particularly difficult. The exact pathophysiologic mechanism of PE as an adverse effect of clozapine is not fully understood, but several interrelated pathophysiological factors are thought to contribute such as drug-induced hypercoagulability, reduced mobility from sedation and weight gain, metabolic disturbances, and inflammation. In the case presented, the patient had a history of thromboembolic events during earlier clozapine therapy, which complicates the decisionmaking process regarding continued use of clozapine.  \n2. Case Presentation  \nMr. X, a man in his late 30s with schizophrenia, was admitted to the psychiatric department of our academic hospital for analysis of cognitive and depressive symptoms. We also wanted to evaluate potential medication changes. Diagnosed with schizophrenia in 2017 following multiple psychotic episodes, he was treated with various medications. His treatment history includes aripiprazole, haloperidol, quetiapine, amisulpride, and clozapine, each with varying success and side effects. He used clozapine in 2022 and 2024, each time followed by deep vein thrombosis (DVT). He previously reported emotional flatness, suicidal ideation, concentration difficulties, and a somber mood with flat affect. Psychomotor retardation, including mild word-finding difficulties, was also noted. The patient was not known to have any other medical conditions at that time.  \nDuring the first episode of DVT in 2022, the patient was in the titration phase of clozapine, although the exact dosage at  \n2 Case Rep","cbCaioV2FkfChqUF","https://ap.wps.com/l/cbCaioV2FkfChqUF","pdf",361370,"English","# Introduction\n# Case Presentation","[{\"question\":\"Why is clozapine considered a gold standard in this case report?\",\"answer\":\"Clozapine is considered the gold standard when first-line antipsychotic treatments are ineffective due to its superior efficacy in reducing psychotic symptoms.\"},{\"question\":\"What thromboembolic complication developed during clozapine therapy?\",\"answer\":\"The patient developed recurrent thromboembolic events, including deep vein thrombosis (DVT) and a second pulmonary embolism (PE) during clozapine treatment.\"},{\"question\":\"How was clozapine managed after pulmonary embolism occurred?\",\"answer\":\"Even after the second PE, clozapine therapy was continued successfully while using concurrent anticoagulation, guided by individualized assessment.\"}]","Clozapine-Associated Pulmonary Embolism - Continuation of Clozapine Therapy With Concurrent Anticoagulation | PDF",1790738946]