Anderson G D, Lin Y X, Berge C, Ojemann G A
Department of Pharmacy, School of Pharmacy, University of Washington, Seattle 98195-7630, USA.
J Neurosurg. 1997 Aug;87(2):252-6. doi: 10.3171/jns.1997.87.2.0252.
Valproate (VPA) is associated with a variety of idiosyncratic hematological effects including thrombocytopenia, inhibition of platelet aggregation, and fibrinogen depletion. This has led some investigators to recommend discontinuation of VPA therapy prior to elective surgical procedures. However, administration of VPA therapy is not altered prior to surgery at the authors' center and no VPA-associated bleeding complications have been observed. Therefore, a retrospective chart review was conducted to verify the clinical observations in patients who had undergone cortical resection while receiving antiepileptic drugs (AEDs). Baseline, surgical, and postoperative laboratory data were available for a total of 313 patients, 111 of whom were receiving VPA and 202 of whom were receiving AEDs without VPA (control patients). Eighty-seven percent of the patients receiving VPA were also being treated with at least one other AED. The control group was approximately equally divided between monotherapy (55%) and polytherapy (45%) treatments. Platelet counts were significantly lower in the control polytherapy (284 +/- 74 x 10(9)/L) and both VPA groups (279 +/- 113 x 10(9)/L) as compared with the control monotherapy group (314 +/- 85 x 10(9)/L). Baseline fibrinogen levels were significantly lower in the VPA than in the control groups (223 +/- 91 g/dl vs. 278 +/- 95 g/dl). Both pre- and postoperatively, the VPA group had lower red blood cells counts, hematocrit, and hemoglobin levels. There was no significant difference between groups in estimated blood loss during surgery or qualitative wound discharge postsurgery. There was only one case of a bleeding complication, which occurred 14 days postoperatively in a patient receiving carbamazepine monotherapy. The results of this study confirm the clinical observations of an absence of bleeding complications in patients receiving VPA therapy at the time of surgery, despite differences in laboratory parameters.
丙戊酸盐（VPA）与多种特异质性血液学效应相关，包括血小板减少、血小板聚集抑制及纤维蛋白原消耗。这使得一些研究者建议在择期外科手术前停用VPA治疗。然而，在作者所在中心，手术前VPA治疗方案并未改变，且未观察到与VPA相关的出血并发症。因此，进行了一项回顾性病历审查，以核实接受抗癫痫药物（AEDs）治疗的患者在接受皮质切除术时的临床观察结果。共有313例患者可获取基线、手术及术后实验室数据，其中111例接受VPA治疗，202例接受不含VPA的AEDs治疗（对照组患者）。接受VPA治疗的患者中，87%还同时接受至少一种其他AEDs治疗。对照组在单药治疗（55%）和联合治疗（45%）之间大致平分。与对照组单药治疗组（314±85×10⁹/L）相比，对照组联合治疗组（284±74×10⁹/L）及两个VPA治疗组（279±113×10⁹/L）的血小板计数均显著降低。VPA组的基线纤维蛋白原水平显著低于对照组（223±91g/dl对278±95g/dl）。术前及术后，VPA组的红细胞计数、血细胞比容及血红蛋白水平均较低。手术期间估计失血量或术后伤口定性引流方面，各治疗组之间无显著差异。仅1例出血并发症，发生在术后14天，该患者接受卡马西平单药治疗。本研究结果证实了临床观察结果，即接受VPA治疗的患者在手术时未出现出血并发症，尽管实验室参数存在差异。
