title: Valproate-associated coagulopathies are frequent and variable in children.
abstract: OBJECTIVE
  Valproic acid (VPA) is an antiepileptic drug (AED) commonly used for generalized and focal epilepsies. The clinical relevance of coagulopathies, known as side effects of VPA therapy, especially thrombocytopenia, von Willebrand disease, and a decrease of factor XIII, is still unclear.
  
  
  METHODS
  In our institute, we noticed a high incidence of clinically relevant coagulation problems related to VPA in eight patients within 1 year only and a further seven children with significant coagulopathy were identified in the context of planned surgery.
  
  
  RESULTS
  We provide an overview of these patients and all six VPA-induced coagulopathies.
  
  
  CONCLUSIONS
  At this time, it cannot be recommended to control all hemostatic parameters in every patient. Whenever an increased bleeding tendency is observed, or before surgical procedures, a platelet count, thrombelastography, prothrombin time, activated partial thromboplastin time, TT, fibrinogen, von Willebrand factor, and factor XIII should be examined. With 385 VPA-treated patients per year and 15 cases of coagulation disorders in this period, we estimate the incidence of coagulation disorders related to VPA in children to be nearly 4%.
authors.affiliation: Department of Pediatrics, Mannheim University Hospital, University of Heidelberg, Heidelberg, Germany. thorsten-gerstner@web.de
authors.forename: Thorsten
authors.initials: T
authors.lastname: Gerstner
authors.forename: Martin
authors.initials: M
authors.lastname: Teich
authors.forename: Nellie
authors.initials: N
authors.lastname: Bell
authors.forename: Elke
authors.initials: E
authors.lastname: Longin
authors.forename: Carl-Erik
authors.initials: CE
authors.lastname: Dempfle
authors.forename: Joachim
authors.initials: J
authors.lastname: Brand
authors.forename: Stephan
authors.initials: S
authors.lastname: König
mesh_terms: D000367:Age Factors; D000927:Anticonvulsants / Q000009:adverse effects* / Q000627:therapeutic use; D001780:Blood Coagulation Tests; D002648:Child; D020147:Coagulation Protein Disorders / Q000139:chemically induced* / Q000453:epidemiology; D004827:Epilepsy / Q000188:drug therapy* / Q000601:surgery; D005260:Female; D006467:Hemophilia A / Q000139:chemically induced / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D011300:Preoperative Care; D012189:Retrospective Studies; D013916:Thrombelastography; D013921:Thrombocytopenia / Q000139:chemically induced* / Q000453:epidemiology; D014635:Valproic Acid / Q000009:adverse effects* / Q000627:therapeutic use; D014842:von Willebrand Diseases / Q000139:chemically induced* / Q000453:epidemiology
chemical_list: D000927:Anticonvulsants; D014635:Valproic Acid