Schädlich D, Friebel D, Schallner J, Gehrisch S, Siegert G, Kuhlisch E, Knöfler R
Universitätsklinikum Carl Gustav Carus Dresden, Klinik und Poliklinik für Kinder- und Jugendmedizin, Bereich Hämatologie, Onkologie und Hämostaseologie, Fetscherstr. 74, 10309 Dresden, Germany.
Hamostaseologie. 2010 Nov;30 Suppl 1:S132-7.
Coagulation parameters were determined in children with valproic acid mono- and valproic acid-lamotrigin combination therapy.
PATIENTS, METHODS: Monotherapy group (n = 22; mean age: 10.5 years) was compared to combination therapy (n = 7; 12.9 years) and a control group (n = 22; 8.7 years). The following parameters were measured: aggregation and ATP-release in whole blood (ADP: 20 μmol/l, collagen: 1 μg/ml, thrombin: 0.5 U/ml), PFA-100® closure times (CT), blood cell counts, global tests, VWF:Ag, VWF:CBA, factors VIII and XIII as well as fibrinogen. Bleeding symptoms were evaluated by using a questionnaire.
For ADP- and collagen-induced aggregation as well as for ATP release no significant differences between the groups were detected. The combined therapy group showed significantly prolonged CT. Von Willebrand disease was not detected in any of the patients. The platelet count was significantly decreased in the monotherapy group. In six children a mild bleeding tendency was observed, mostly epistaxis.
A clinically relevant influence of valproic acid on haemostasis was found only in few cases. However, before surgical procedures an extended coagulation diagnostics is recommended in patients with valproic acid therapy.
对接受丙戊酸单药治疗和丙戊酸 - 拉莫三嗪联合治疗的儿童进行凝血参数测定。
患者、方法：将单药治疗组（n = 22；平均年龄：10.5岁）与联合治疗组（n = 7；12.9岁）及对照组（n = 22；8.7岁）进行比较。测定以下参数：全血中的聚集和ATP释放（ADP：20μmol/l，胶原：1μg/ml，凝血酶：0.5U/ml）、PFA - 100® 封闭时间（CT）、血细胞计数、整体检测、血管性血友病因子抗原（VWF:Ag）、血管性血友病因子胶原结合活性（VWF:CBA）、因子VIII和XIII以及纤维蛋白原。通过问卷评估出血症状。
在ADP和胶原诱导的聚集以及ATP释放方面，各组之间未检测到显著差异。联合治疗组的CT显著延长。所有患者均未检测到血管性血友病。单药治疗组的血小板计数显著降低。在6名儿童中观察到轻度出血倾向，主要为鼻出血。
仅在少数病例中发现丙戊酸对止血有临床相关影响。然而，对于接受丙戊酸治疗的患者，在手术前建议进行扩展的凝血诊断。
