RESUMEN
PURPOSE: 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%.
Asunto(s)
Anticonvulsivantes/efectos adversos , Trastornos de las Proteínas de Coagulación/inducido químicamente , Epilepsia/tratamiento farmacológico , Trombocitopenia/inducido químicamente , Ácido Valproico/efectos adversos , Enfermedades de von Willebrand/inducido químicamente , Factores de Edad , Anticonvulsivantes/uso terapéutico , Pruebas de Coagulación Sanguínea , Niño , Trastornos de las Proteínas de Coagulación/epidemiología , Epilepsia/cirugía , Femenino , Hemofilia A/inducido químicamente , Hemofilia A/epidemiología , Humanos , Incidencia , Lactante , Masculino , Cuidados Preoperatorios , Estudios Retrospectivos , Tromboelastografía , Trombocitopenia/epidemiología , Ácido Valproico/uso terapéutico , Enfermedades de von Willebrand/epidemiologíaAsunto(s)
Anticoagulantes/envenenamiento , Trastornos de las Proteínas de Coagulación/inducido químicamente , Rodenticidas/envenenamiento , Adolescente , Adulto , Trastornos de las Proteínas de Coagulación/diagnóstico , Trastornos de las Proteínas de Coagulación/terapia , Femenino , Humanos , MasculinoRESUMEN
We compared the effects of two third-generation progestogens, desogestrel (DSG) and gestodene (GSD), on coagulation and fibrinolysis in Brazilian users of oral contraceptives (OCs). Forty-six women were evaluated before treatment and after six cycles of treatment. The coagulation, anticoagulant, and fibrinolytic systems were investigated. During the use of the DSG-containing OC, the activity of factors VII, VIII, IX, X, and XII increased significantly whereas the GSD-containing OC caused no changes in coagulation parameters. Concerning the anticoagulant pathways, the DSG-containing OC increased protein C levels and decreased total protein S levels, and the GSD-containing OC only decreased total protein S. Both OCs increased plasminogen activity, although the DSG-containing OC increased fibrin degradation products levels and decreased the tissue plasminogen activator antigen. In conclusion, we have found that in Brazilian women the effects of DSG and GSD on hemostatic parameters are different and, therefore, third-generation progestogens may not contribute equally to the thrombotic risk.
Asunto(s)
Trastornos de las Proteínas de Coagulación/prevención & control , Anticonceptivos Sintéticos Orales/farmacología , Desogestrel/farmacología , Hemostasis/efectos de los fármacos , Norpregnenos/farmacología , Congéneres de la Progesterona/farmacología , Adulto , Coagulación Sanguínea/efectos de los fármacos , Brasil/epidemiología , Trastornos de las Proteínas de Coagulación/sangre , Trastornos de las Proteínas de Coagulación/inducido químicamente , Trastornos de las Proteínas de Coagulación/epidemiología , Anticonceptivos Orales/efectos adversos , Anticonceptivos Sintéticos Orales/administración & dosificación , Desogestrel/administración & dosificación , Etnicidad , Femenino , Fibrinólisis/efectos de los fármacos , Humanos , Norpregnenos/administración & dosificación , Congéneres de la Progesterona/administración & dosificaciónAsunto(s)
Trastornos de las Proteínas de Coagulación/veterinaria , Enfermedades de los Perros/inducido químicamente , Enfermedades de los Perros/diagnóstico , Precalicreína/deficiencia , Rodenticidas/envenenamiento , Animales , Trastornos de las Proteínas de Coagulación/inducido químicamente , Trastornos de las Proteínas de Coagulación/diagnóstico , Diagnóstico Diferencial , Perros , Femenino , Tiempo de Tromboplastina Parcial/veterinaria , Intoxicación/veterinariaRESUMEN
A 17-year-old patient with Shone's disease had to be readmitted to the hospital 3 months after implantation of an artificial aortic valve because of extreme mitral insufficiency with consecutive pulmonary edema and hepatic dysfunction. He had been orally anticoagulated and presented with a high international normalized ratio of 6.7. Emergency replacement of the mitral valve was possible only after administration of prothrombin-complex concentrate, as vitamin K(1) and fresh frozen plasma did not correct the hemostatic defect sufficiently.