Mansoor Areesha, Shahzad Maryam, Zulfiqar Eeshal, Ahsan Muneeba, Adnan Rimsha, Shaeen Sean Kaisser, Banatwala Umm E Salma Shabbar, Malikzai Abdullah
Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan.
Kabul University of Medical Sciences, Kabul, Afghanistan.
Drugs Real World Outcomes. 2025 Mar;12(1):1-15. doi: 10.1007/s40801-024-00462-x. Epub 2025 Jan 3.
Anti-seizure medications (ASMs) are specific types of anticonvulsants used to treat epileptic seizures. However, several studies have shown an association between ASMs and an increased risk of hematological disorders, such as thrombocytopenia, aplastic anemia, and platelet function disorders leading to prolonged bleeding times. This review explores the existing literature on this topic, investigating a wide variety of ASMs, ranging from first-generation medications to newer ones. A comprehensive search was conducted on all the currently approved ASMs using PubMed and Google Scholar: review articles, clinical trials, meta-analysis, observational studies, case reports, and relevant animal studies were identified. We extracted 15 ASMs including valproic acid (VPA), carbamazepine, phenytoin, phenobarbital, diazepam, clonazepam, lamotrigine, levetiracetam, oxcarbazepine, felbamate, topiramate, pregabalin, lacosamide, cannabidiol (CBD), and perampanel that contain considerable literature regarding different coagulopathies. An in-depth review of over 140 studies revealed a robust association between ASM-induced changes and the onset of bleeding disorders via several different mechanisms. Polytherapy, the use of multiple ASMs, also emerged as a significant risk factor for the development of coagulopathies. This review highlights the potential link between ASMs and bleeding disorders, emphasizing the importance of considering this risk during treatment planning. By understanding these associations, healthcare providers can optimize patient outcomes and minimize bleeding risks. Additionally, this review identifies the need for further research to bridge current knowledge gaps in clinical pharmacology related to ASMs and bleeding disorders.
抗癫痫药物（ASMs）是用于治疗癫痫发作的特定类型的抗惊厥药。然而，多项研究表明，ASMs与血液系统疾病风险增加之间存在关联，如血小板减少症、再生障碍性贫血以及导致出血时间延长的血小板功能障碍。本综述探讨了关于该主题的现有文献，研究了从第一代药物到新型药物等多种ASMs。使用PubMed和谷歌学术对所有目前已获批的ASMs进行了全面检索：确定了综述文章、临床试验、荟萃分析、观察性研究、病例报告及相关动物研究。我们提取了15种ASMs，包括丙戊酸（VPA）、卡马西平、苯妥英、苯巴比妥、地西泮、氯硝西泮、拉莫三嗪、左乙拉西坦、奥卡西平、非氨酯、托吡酯、普瑞巴林、拉科酰胺、大麻二酚（CBD）和吡仑帕奈，这些药物包含了大量关于不同凝血障碍的文献。对140多项研究的深入综述揭示了ASM诱导的变化与通过几种不同机制引发的出血性疾病之间存在密切关联。联合使用多种ASMs的多药疗法也成为凝血障碍发生的一个重要危险因素。本综述强调了ASMs与出血性疾病之间的潜在联系，强调了在治疗规划中考虑这一风险的重要性。通过了解这些关联，医疗保健提供者可以优化患者治疗效果并将出血风险降至最低。此外，本综述指出有必要进一步开展研究，以弥补当前与ASMs和出血性疾病相关的临床药理学知识空白。
