Acquired von Willebrand syndrome as side effect of valproic acid therapy in children is rare

Summary

To determine the frequency and clinical relevance of acquired von Willebrand syndrome (aVWS) due to antiepileptic therapy by valproic acid, we investigated 50 consecutive children in three neuropediatric institutions. Coagulation factors were determined in local laboratories before and three times after starting therapy with valproic acid. Parameters of von Willebrand factor (VWF) were additionally investigated in a reference laboratory including multimeric analysis. Significant changes in the coagulation system were found concerning fibrinogen (decreased from 287 ± 70 mg/dl to 222 ± 67 mg/dl; p < 0.001) and platelet count. Changes of VWF para -meters were also found but no patient developed laboratory defined aVWS. We conclude that the bleeding tendency observed in some children undergoing antiepileptic therapy with valproic acid is not due to aVWS.

Zusammenfassung

Um die Häufigkeit und die Relevanz eines durch eine antiepileptische Valproat-Therapie erworbenen von-Willebrand-Syndroms (VWS) bei Kindern zu erfassen, untersuchten wir 50 konsekutive Fälle in drei neuropädiatrischen Institutionen. Hämostaseparameter wurden vorher und dreimal im Laufe der Therapie erhoben. Von-Willebrand-Faktor(VWF)-Para -meter einschließlich Multimeranalyse, wurden zusätzlich in einem Referenzlabor bestimmt. Die Behandlung der Kinder mit Valproinsäure führte zu häufigen Veränderungen der Hämostase wie Hypofibrinogenämie (Abfall von 287 ± 70 mg/dl auf 222 ± 67 mg/dl; p < 0,001) und Thrombozytopenie. Veränderungen der VWF-Parameter waren jedoch marginal und rechtfertigten bei keinem Patienten die Diagnose eines erworbenen VWS. Die bei einigen Patienten beobachtete Blutungsneigung unter Valproinsäure ist daher nicht auf ein erworbenes VWS zurückzuführen.

Keywords

Acquired von Willebrand syndrome - valproic acid

Schlüsselwörter

Erworbenes von-Willebrand-Syndrom - Valproat

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