Department of Neurology, Konkuk University School of Medicine, Seoul, South Korea.
Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea.
J Clin Pharm Ther. 2020 Oct;45(5):1014-1020. doi: 10.1111/jcpt.13125. Epub 2020 Feb 10.
Thrombocytopenia is a common laboratory abnormality among critically ill patients under neurological intensive care unit (NCU) care. Valproic acid (VPA), a widely used antiepileptic drug, is one of the common causes of drug-induced thrombocytopenia. The purpose of this study was to estimate the incidence and risk factors of thrombocytopenia after intravenous VPA therapy among the patients admitted to NCU.
We retrospectively reviewed the medical records of patients who were treated with intravenous VPA during their NCU stay between January 2014 and December 2018. We studied the frequency of thrombocytopenia and further evaluated the risk of thrombocytopenia in these patients.
Among the 283 patients (181 male [64.0%], mean age: [61.0 ± 14.9] years) who were treated with intravenous VPA, thrombocytopenia was observed in 104 patients (36.7%). Thrombocytopenia was associated with several risk factors, including lower baseline platelet counts (<200 × 10 /L); aetiologies other than intracranial or subarachnoid haemorrhage; longer use of VPA (more than 3 days); higher daily dose of VPA (more than 1000 mg/d); concurrent use of VPA with other antiepileptic drugs; infection; and the use of mechanical ventilation. Multivariate analysis found several independent risk factors of thrombocytopenia with intravenous VPA therapy, including lower baseline platelet counts, aetiologies other than intracranial or subarachnoid haemorrhage, use of VPA for more than 3 days and infection.
Thrombocytopenia is common in NCU patients. Because several clinical and laboratory factors are associated with thrombocytopenia, careful use of VPA should be considered in patients with these risk factors.
血小板减少症是神经重症监护病房（NCU）中重症患者常见的实验室异常。丙戊酸（VPA）是一种广泛使用的抗癫痫药物，也是药物引起血小板减少症的常见原因之一。本研究旨在评估 NCU 住院患者静脉用 VPA 治疗后血小板减少症的发生率和危险因素。
我们回顾性分析了 2014 年 1 月至 2018 年 12 月期间在 NCU 期间接受静脉 VPA 治疗的患者的病历。我们研究了血小板减少症的频率，并进一步评估了这些患者血小板减少症的风险。
在 283 例（181 例男性[64.0%]，平均年龄[61.0±14.9]岁）接受静脉 VPA 治疗的患者中，104 例（36.7%）发生血小板减少症。血小板减少症与多种危险因素相关，包括基线血小板计数较低（<200×10 /L）；病因不是颅内或蛛网膜下腔出血；VPA 使用时间较长（超过 3 天）；VPA 日剂量较高（超过 1000mg/d）；VPA 与其他抗癫痫药物同时使用；感染；以及使用机械通气。多变量分析发现，静脉用 VPA 治疗引起血小板减少症的几个独立危险因素包括基线血小板计数较低、颅内或蛛网膜下腔出血以外的病因、VPA 使用超过 3 天和感染。
血小板减少症在 NCU 患者中很常见。由于有几个临床和实验室因素与血小板减少症有关，因此在有这些危险因素的患者中应谨慎使用 VPA。
