This Article Full Text (PDF) References Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via Google Scholar Citing Articles via Scopus Google Scholar Articles by Serdaroglu, G. Articles by Tekgiil, H. Search for Related Content PubMed PubMed Citation Articles by Serdaroglu, G. Articles by Tekgiil, H. Social Bookmarking                         What's this?

Coagulation Abnormalities and Acquired von Willebrand's Disease Type 1 in Children Receiving Valproic Acid

Department of Pediatrics Division of Child Neurology

Sarenur Tütüncüolu, MD

Department of Pediatrics Division of Child Neurology

Kaan Kavakli, MD

Department of Pediatrics Division of Pediatric Hematology

Hasan Tekgiil, MD

Department of Pediatrics Division of Child Neurology Ege University Faculty of Medicine -Izmir, Turkey

Valproic acid is commonly used in the management of childhood epilepsy. The known hematologic side effects of the drug are hemorrhagic diatheses, thrombocytopenia, and hypofibrinogenemia. We studied coagulation parameters in 29 epileptic children receiving valproic acid for at least 6 months. Their ages ranged between 2 and 18 years (10.2 ± 4.9 years). The total valproic acid dose was 250 to 1000 mg/day equivalent to 20 to 30 mg/kg/day Treatment duration ranged from 6 to 57 months. These children had not previously had a hemostatic defect and had no family history of bleeding disorders. Platelet count, prothrombin time, activated partial thromboplastin time, bleeding time, fibrinogen, platelet aggregation assays, and ristocetin cofactor activity levels were determined in all of the patients, but von Willebrand's factor antigen levels could be determined in only 14 patients. The values of von Willebrand's factor antigen ranged from 53 to 218% (104.1 ± 42.3), and ristocetin cofactor activity levels ranged from 11.5 to 218% (94.5 ± 43.1). Six of the 29 children (20.7%) had decreased values of ristocetin and cofactor activity and were considered to have acquired von Willebrand's disease. The decreases in coagulation parameters were not dependent on either valproic acid dose or treatment duration. Two patients with low ristocetin cofactor activity values had mild epistaxis, which did not require discontinuation of therapy. In patients receiving valproic acid therapy, this side effect must be considered, especially before surgical intervention and serious traumatic conditions. (J Child Neurol 2002;17:41-43).

Journal of Child Neurology, Vol. 17, No. 1, 41-43 (2002)
DOI: 10.1177/088307380201700110


CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter    What's this?