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Merideth F, Jabaily JB, Daunis D, Kontos N. C-L Case Conference: Explicit, Implicit, and Tacit Consultation Questions for a Patient with Idiopathic Thrombocytopenic Purpura and Agitation. J Acad Consult Liaison Psychiatry 2024:S2667-2960(24)00069-7. [PMID: 39004344 DOI: 10.1016/j.jaclp.2024.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 06/06/2024] [Accepted: 07/08/2024] [Indexed: 07/16/2024]
Abstract
We present the case of a 23-year-old man with a complex psychiatric history who was transferred from a community hospital for management of agitation and severe thrombocytopenia. Experts in consultation-liaison psychiatry deconstruct the consultation question in this case. The importance of addressing superficial and hidden aspects of a consultation are reviewed via the concepts of explicit, implicit, and tacit consultation questions.
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Affiliation(s)
- Flannery Merideth
- Department of Psychiatry, UMass Chan Medical School- Baystate, Springfield, MA.
| | - Joseph B Jabaily
- Department of Psychiatry, UMass Chan Medical School- Baystate, Springfield, MA
| | - Daniel Daunis
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN
| | - Nicholas Kontos
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA
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Schuler M, Shammout A, Asif M, Mullikin A. Valproic Acid-Induced Thrombocytopenia in Treatment-Resistant GABRB3 Genetic Epilepsy: A Case Report. Cureus 2024; 16:e57030. [PMID: 38681313 PMCID: PMC11046339 DOI: 10.7759/cureus.57030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/27/2024] [Indexed: 05/01/2024] Open
Abstract
Valproic acid (VPA) is utilized in the management of a variety of seizure and mood disorders. A rare side effect of this medication is dose-dependent thrombocytopenia. In this case, we report a patient with a treatment-resistant epilepsy GABRB3 genetic variant phenotype who was admitted for sepsis and found to have significant thrombocytopenia with clinical manifestations of epistaxis and easy bruising, which was found to be due to VPA use rather than secondary to other clinical pathologies. The patient's clinical condition improved with supportive treatment including fluid rehydration. Platelet counts normalized after a transfusion and holding of her valproate. She experienced breakthrough seizures despite the initiation of diazepam. The decision was made to restart VPA per Neurology consult recommendations for better seizure control. She had no breakthrough seizures reported after restarting VPA in the hospital. This case highlights the importance of monitoring antiseizure medication side effects, especially in populations at higher risk due to treatment resistance.
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Affiliation(s)
- Matthew Schuler
- Pediatrics, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, USA
| | - Ali Shammout
- Pediatrics, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, USA
| | - Maria Asif
- Pediatrics, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, USA
| | - Amy Mullikin
- Internal Medicine/Pediatrics, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, USA
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Nicole Gilliam D, Sarangarm P, Elwood K. A Retrospective Case Series on Valproic Acid for Early Post-Traumatic Seizure Prophylaxis After Traumatic Brain Injury in Patients With Concomitant Agitation. Hosp Pharm 2023; 58:496-503. [PMID: 37711412 PMCID: PMC10498971 DOI: 10.1177/00185787231160435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/16/2023]
Abstract
Purpose: Early post-traumatic seizures occur within 7 days following a traumatic brain injury and may lead to additional brain damage and poor outcomes. Levetiracetam or phenytoin is often used for seizure prophylaxis in this patient population, but valproic acid may be an appropriate therapeutic alternative in patients with concomitant agitation. Evidence for the use of valproic acid for both early post-traumatic seizure prophylaxis and agitation is limited. The purpose of this study is to examine the safety and efficacy of valproic acid for both early post-traumatic seizure prophylaxis and agitation. Methods: This single-center, retrospective case series includes 18 patients who received valproic acid for both early post-traumatic seizure prophylaxis and agitation. Efficacy for early post-traumatic seizure prophylaxis is assessed by the incidence of seizures within 7 days of injury. Efficacy for agitation is assessed by changes in Riker Sedation-Agitation Scale scores during valproic acid therapy. The safety of valproic acid is defined by the incidence of selected adverse events. Results: Among 18 patients with traumatic brain injuries receiving valproic acid for both early post-traumatic seizures and agitation, one patient experienced a seizure during the period of prophylaxis and thrombocytopenia was the most common adverse event. Conclusion: In this small cohort of patients, valproic acid appears be a potential option to prevent early post-traumatic seizures in patients with traumatic brain injuries and concomitant agitation with minimal adverse effects. Randomized, controlled studies are needed to further investigate the role of valproic acid for this indication, including standards for dosing regimens, serum drug monitoring, and the relationship between valproic acid treatment and mortality.
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Pathak SM, Ziechmann R, Menzer J, Hoeft A, Villanueva P. Discontinuation of Levetiracetam and Valproic Acid Due to Adverse Effects in Early Post-traumatic Seizure Prophylaxis. Cureus 2023; 15:e47742. [PMID: 38021754 PMCID: PMC10676217 DOI: 10.7759/cureus.47742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2023] [Indexed: 12/01/2023] Open
Abstract
INTRODUCTION Levetiracetam (LEV) and valproic acid (VPA) are two anti-epileptic drugs (AEDs) routinely used for post-traumatic seizure (PTS) prophylaxis at our institution. In our practice, VPA is used for its beneficial effects on behavioral agitation and headaches, but it is also associated with abnormal liver function tests (LFTs). Both medications may be associated with thrombocytopenia. There is less literature comparing the adverse effect profiles and discontinuation rates of LEV and VPA in the context of PTS prophylaxis. We conducted a quality improvement (QI) analysis to determine the safety of LEV and VPA for traumatic brain injury (TBI) patients at our institution. In particular, our QI analysis involved calculating the rates of discontinuation or change of drug regimen due to the adverse effects. METHODS Our QI analysis focused on patients treated for TBI at our institution during a six-year period. We recorded the AED used and if the AED was discontinued or switched due to thrombocytopenia, behavioral agitation, headaches, or elevated LFTs (including elevated aspartate aminotransferase or alanine aminotransferase values). We also recorded the incidence of early PTS, defined as seizures within seven days of the TBI. RESULTS Our QI analysis included patients with a mean age of approximately 49 years with nearly 75% males. The mean Glasgow Coma Scale (GCS) score was 12.88, with 73.11% of patients having a mild GCS. The three leading injury mechanisms were fall, assault, and motor vehicle collision. The three leading types of TBI were traumatic subarachnoid hemorrhage, subdural hematoma, and cerebral contusion. Among patients with no prior history of seizures, we found an early PTS incidence of 7.28%. For patients administered LEV and VPA, 0.11% (1/898) and 3.85% (4/104) had the medication discontinued or changed because of thrombocytopenia (p < 0.001), respectively. For patients on LEV, 4.01% (36/898) and 1.78% (16/898) had the medication discontinued or changed because of behavioral agitation and headaches, respectively. For patients on VPA, 2.88% (3/104) had the medication discontinued or changed because of hepatotoxicity. In total, 5.90% versus 6.73% (p > 0.5) of patients on LEV and VPA, respectively, had their medication regimens changed due to the adverse effects. CONCLUSIONS The incidence of early PTS in our patients is within the range of what has been reported in the literature. The rate of discontinuation of LEV and VPA on account of adverse events is low in the context of PTS prophylaxis. Both medications had similar overall rates of discontinuation. VPA was discontinued more frequently than LEV due to thrombocytopenia, but discontinuation was not common in either case. LEV is associated with behavioral agitation and headaches, which makes VPA a desirable alternative for patients suffering from these symptoms.
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Affiliation(s)
- Sami M Pathak
- Neurosurgery, Temple University Hospital, Philadelphia, USA
| | | | - Jacob Menzer
- Neurosurgery, Temple University Hospital, Philadelphia, USA
| | - Ava Hoeft
- Neurological Surgery, Southern Illinois University School of Medicine, Springfield, USA
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Almuhanna RA, Muddassir R, Almaghrabi M, Bokhari G, Al-Ghamdi A. Perampanel-Induced, New-Onset Thrombocytopenia in a Patient With Refractory Seizures: A Case Report. Cureus 2023; 15:e37781. [PMID: 37213988 PMCID: PMC10195002 DOI: 10.7759/cureus.37781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2023] [Indexed: 05/23/2023] Open
Abstract
Perampanel (Fycompa) is a glutamate receptor antagonist known to be a safe, effective, and well-tolerated medication; nevertheless, adverse effects are possible. This case report aims to raise the suspicion of perampanel-induced thrombocytopenia and discuss its possible pathways implicated. Here, we present the case of a 66-year-old female patient with a generalized tonic-clonic seizure initially managed with levetiracetam, valproic acid, and lacosamide; however, the patient continued to have seizures clinically as well as on the electroencephalogram. The patient was initiated on 2 mg of perampanel and reached up to 12 mg within a week, after which the seizure was controlled. Nevertheless, after perampanel initiation, a gradual platelet count reduction was observed. Upon withdrawal of perampanel, the platelet count dramatically improved reaching up to her baseline. Although perampanel is known to be a safe medication, a hematological complication such as thrombocytopenia is possible. The exact mechanism remains unclear. Further studies are required to understand the association between thrombocytopenia and perampanel to identify high-risk populations and prevent this condition sequentially.
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Affiliation(s)
| | | | - Murouj Almaghrabi
- Medicine and Surgery, College of Medicine, Umm Al-Qura University, Makkah, SAU
| | - Gadir Bokhari
- Medicine, College of Medicine, Umm Al-Qura University, Makkah, SAU
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Kietaibl S, Ahmed A, Afshari A, Albaladejo P, Aldecoa C, Barauskas G, De Robertis E, Faraoni D, Filipescu DC, Fries D, Godier A, Haas T, Jacob M, Lancé MD, Llau JV, Meier J, Molnar Z, Mora L, Rahe-Meyer N, Samama CM, Scarlatescu E, Schlimp C, Wikkelsø AJ, Zacharowski K. Management of severe peri-operative bleeding: Guidelines from the European Society of Anaesthesiology and Intensive Care: Second update 2022. Eur J Anaesthesiol 2023; 40:226-304. [PMID: 36855941 DOI: 10.1097/eja.0000000000001803] [Citation(s) in RCA: 60] [Impact Index Per Article: 60.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
BACKGROUND Management of peri-operative bleeding is complex and involves multiple assessment tools and strategies to ensure optimal patient care with the goal of reducing morbidity and mortality. These updated guidelines from the European Society of Anaesthesiology and Intensive Care (ESAIC) aim to provide an evidence-based set of recommendations for healthcare professionals to help ensure improved clinical management. DESIGN A systematic literature search from 2015 to 2021 of several electronic databases was performed without language restrictions. Grading of Recommendations, Assessment, Development and Evaluation (GRADE) was used to assess the methodological quality of the included studies and to formulate recommendations. A Delphi methodology was used to prepare a clinical practice guideline. RESULTS These searches identified 137 999 articles. All articles were assessed, and the existing 2017 guidelines were revised to incorporate new evidence. Sixteen recommendations derived from the systematic literature search, and four clinical guidances retained from previous ESAIC guidelines were formulated. Using the Delphi process on 253 sentences of guidance, strong consensus (>90% agreement) was achieved in 97% and consensus (75 to 90% agreement) in 3%. DISCUSSION Peri-operative bleeding management encompasses the patient's journey from the pre-operative state through the postoperative period. Along this journey, many features of the patient's pre-operative coagulation status, underlying comorbidities, general health and the procedures that they are undergoing need to be taken into account. Due to the many important aspects in peri-operative nontrauma bleeding management, guidance as to how best approach and treat each individual patient are key. Understanding which therapeutic approaches are most valuable at each timepoint can only enhance patient care, ensuring the best outcomes by reducing blood loss and, therefore, overall morbidity and mortality. CONCLUSION All healthcare professionals involved in the management of patients at risk for surgical bleeding should be aware of the current therapeutic options and approaches that are available to them. These guidelines aim to provide specific guidance for bleeding management in a variety of clinical situations.
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Affiliation(s)
- Sibylle Kietaibl
- From the Department of Anaesthesiology & Intensive Care, Evangelical Hospital Vienna and Sigmund Freud Private University Vienna, Austria (SK), Department of Anaesthesia and Critical Care, University Hospitals of Leicester NHS Trust (AAh), Department of Cardiovascular Sciences, University of Leicester, UK (AAh), Department of Paediatric and Obstetric Anaesthesia, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark (AAf), Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark (AAf), Department of Anaesthesiology & Critical Care, CNRS/TIMC-IMAG UMR 5525/Themas, Grenoble-Alpes University Hospital, Grenoble, France (PA), Department of Anaesthesiology & Intensive Care, Hospital Universitario Rio Hortega, Valladolid, Spain (CA), Department of Surgery, Lithuanian University of Health Sciences, Kaunas, Lithuania (GB), Division of Anaesthesia, Analgesia, and Intensive Care - Department of Medicine and Surgery, University of Perugia, Italy (EDR), Department of Anesthesiology, Perioperative and Pain Medicine, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA (DFa), University of Medicine and Pharmacy Carol Davila, Department of Anaesthesiology & Intensive Care, Emergency Institute for Cardiovascular Disease, Bucharest, Romania (DCF), Department of Anaesthesia and Critical Care Medicine, Medical University Innsbruck, Innsbruck, Austria (DFr), Department of Anaesthesiology & Critical Care, APHP, Université Paris Cité, Paris, France (AG), Department of Anesthesiology, University of Florida, College of Medicine, Gainesville, Florida, USA (TH), Department of Anaesthesiology, Intensive Care and Pain Medicine, St.-Elisabeth-Hospital Straubing, Straubing, Germany (MJ), Department of Anaesthesiology, Medical College East Africa, The Aga Khan University, Nairobi, Kenya (MDL), Department of Anaesthesiology & Post-Surgical Intensive Care, University Hospital Doctor Peset, Valencia, Spain (JVL), Department of Anaesthesiology & Intensive Care, Johannes Kepler University, Linz, Austria (JM), Department of Anesthesiology & Intensive Care, Semmelweis University, Budapest, Hungary (ZM), Department of Anaesthesiology & Post-Surgical Intensive Care, University Trauma Hospital Vall d'Hebron, Barcelona, Spain (LM), Department of Anaesthesiology & Intensive Care, Franziskus Hospital, Bielefeld, Germany (NRM), Department of Anaesthesia, Intensive Care and Perioperative Medicine, GHU AP-HP. Centre - Université Paris Cité - Cochin Hospital, Paris, France (CMS), Department of Anaesthesiology and Intensive Care, Fundeni Clinical Institute, Bucharest and University of Medicine and Pharmacy Carol Davila, Bucharest, Romania (ES), Department of Anaesthesiology and Intensive Care Medicine, AUVA Trauma Centre Linz and Ludwig Boltzmann-Institute for Traumatology, The Research Centre in Co-operation with AUVA, Vienna, Austria (CS), Department of Anaesthesia and Intensive Care Medicine, Zealand University Hospital, Roskilde, Denmark (AW) and Department of Anaesthesiology, Intensive Care Medicine & Pain Therapy, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany (KZ)
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Ahmed Z, Subhan F, Ahmed S. Fixed Dose Combination Tablets of Aripiprazole and Divalproex Sodium: a Pilot Pharmacokinetic Study in Human Volunteers. AAPS PharmSciTech 2022; 23:232. [DOI: 10.1208/s12249-022-02378-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 07/25/2022] [Indexed: 11/30/2022] Open
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Valproic Acid During Hypotensive Resuscitation In Pigs With Trauma And Hemorrhagic Shock Does Not Improve Survival. J Trauma Acute Care Surg 2022; 93:S128-S135. [PMID: 35583983 DOI: 10.1097/ta.0000000000003705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Valproic acid (VPA) has been extensively used for treatment of anxiety and seizure. Recent studies have shown that VPA has cellular protective effects in preclinical models following severe hemorrhage. This study investigated the effects of VPA on coagulation and survival in pigs after traumatic hemorrhage and hypotensive resuscitation. METHODS Following baseline measurements, femur fracture was performed in 20 anesthetized and instrumented pigs (41 ± 2 kg), followed by hemorrhage of 55% of the estimated blood volume and a 10 min shock period. Pigs were then resuscitated over 30 min with: normal saline alone (NS group, n = 10, 4 ml/kg) or VPA solution (VPA group, n = 10, 90 mg/kg, 2 ml/kg of 45 mg VPA/ml, plus 2 ml NS/kg). All pigs were then monitored for 2 hrs or until death. Hemodynamics were recorded and blood samples were taken for blood and coagulation analysis (Rotem®) at baseline, after hemorrhage, resuscitation, and 2 hrs or death. RESULTS Femur fracture and hemorrhage caused similar reductions in mean arterial pressure (MAP) and cardiac output and increase in heart rate in both groups. Resuscitation with NS or VPA did not return these measurements to baseline. No differences were observed in hematocrit, pH, lactate, base excess, or total protein between the groups. Compared to NS, resuscitation with VPA decreased platelet counts and prolonged aPTT, with no differences in fibrinogen levels, PT, or any of the Rotem® measurements between the two groups. Neither survival rates (NS: 7 of 10 pigs and VPA: 7 of 10 pigs) nor survival times after resuscitation (NS: 97 ± 40 min and VPA: 98 ± 43 min) differed between the groups. CONCLUSIONS Following traumatic hemorrhage and hypotensive resuscitation in pigs, VPA provides no benefit towards improving coagulation function or survival times. LEVELS OF RELEVANCE N/A.
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Young MR, Bisaccia EK, Romantseva L, Hovey SW. Valproic Acid Serum Concentration and Incidence of Toxicity in Pediatric Patients. J Child Neurol 2022; 37:461-470. [PMID: 35253521 DOI: 10.1177/08830738221083480] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In certain pediatric patients on valproic acid, therapeutic range (50-100 μg/mL) is maximized or exceeded to achieve better seizure control. This study compared incidence of common valproic acid adverse effects (thrombocytopenia, hepatotoxicity, and hyperammonemia) across maintenance concentration and age group. One hundred twenty-four children on maintenance valproic acid between January 2013 and January 2021 were eligible for inclusion. Fifty-six patients were maintained in concentration range 50 to 80 μg/mL, an additional 44 between 80 and 100 μg/mL and 24 between 100 and 120 μg/mL. Forty-one patients were prepubescent, 57 pubescent, and 26 postpubescent. There were no statistically significant differences observed in the primary endpoint of thrombocytopenia across serum concentration range (P = .093) or age group (P = .628). No significant differences in hepatic dysfunction (P = .099) or hyperammonemia (P = .548) were observed in serum concentration groups. Similarly, age group analysis observed no difference in hepatic dysfunction (P = .615) or hyperammonemia (P = .369). Serum valproic acid levels >100 μg/mL can be considered in select pediatric patients based on this study.
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Affiliation(s)
- McKenzie R Young
- Department of Pharmacy, 2468Rush University Medical Center, Chicago, IL, USA
| | - Elizabeth K Bisaccia
- Department of Pharmacy, 21886Advocate Lutheran General Hospital, Park Ridge, IL, USA
| | - Lubov Romantseva
- Section of Pediatric Neurology, Department of Pediatrics, 2468Rush University Medical Center, Chicago, IL, USA
| | - Sara W Hovey
- Department of Pharmacy, 2468Rush University Medical Center, Chicago, IL, USA
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Co-targeting leukemia-initiating cells and leukemia bulk leads to disease eradication. Leukemia 2022; 36:1306-1312. [PMID: 35246604 DOI: 10.1038/s41375-022-01530-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 01/28/2022] [Accepted: 02/14/2022] [Indexed: 12/13/2022]
Abstract
According to a hierarchical model, targeting leukemia-initiating cells (LICs) was speculated to achieve complete remission (CR) or cure. Nonetheless, increasing evidence emphasized the plasticity of differentiated blasts undergoing interconversion into LICs. We exploited murine models of acute promyelocytic leukemia (APL), a subtype of acute myeloid leukemia driven by the promyelocytic leukemia/retinoic acid receptor (PML-RARα) oncofusion protein, which recruits histone deacetylase (HDAC)-containing complexes. We studied APLs with different LIC frequencies and investigated the effect of two HDAC inhibitors: valproic acid (VPA), with relative selectivity towards class I HDAC enzymes and vorinostat/suberoylanilide hydroxamic acid (SAHA) (pan-HDAC inhibitor) in combination with all-trans retinoic acid (ATRA), on the bulk APL cells and APL LICs. Indeed, we found that while VPA differentiates the bulk APL cells, SAHA selectively targets LICs. ATRA + VPA + SAHA combination efficiently induced CR in an APL model with lower LIC frequency. Substituting ATRA with synthetic retinoids as etretinate which promotes APL differentiation without downregulating PML/RARα compromised the therapeutic benefit of ATRA + VPA + SAHA regimen. Altogether, our study emphasizes the therapeutic power of co-targeting the plasticity and heterogeneity of cancer -herein demonstrated by tackling LICs and bulk leukemic blasts - to achieve and maintain CR.
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Jaitpal V, Gawande S. Valproate-Induced Bicytopenia: A Case Study. Cureus 2022; 14:e22327. [PMID: 35371645 PMCID: PMC8938205 DOI: 10.7759/cureus.22327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2022] [Indexed: 11/05/2022] Open
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Elvir-Lazo OL, White PF, Cruz Eng H, Yumul F, Chua R, Yumul R. Impact of chronic medications in the perioperative period -anesthetic implications (Part II). Postgrad Med 2021; 133:920-938. [PMID: 34551658 DOI: 10.1080/00325481.2021.1982298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Background: This review article discusses the pharmacodynamic effects of the most commonly used chronic medications by patients undergoing elective surgical procedures, namely cardiovascular drugs (e.g., beta blockers, alpha-2 agonist, calcium channel blockers, ACE inhibitors, diuretics, etc.), lipid-lowering drugs, gastrointestinal medications (H2-blockers, proton pump inhibitors), pulmonary medications (inhaled β-agonists, anticholinergics,), antibiotics (tetracyclines, clindamycin and macrolide, linezolid.), opioids and non-opioids analgesics (NSAIDs, COX-2 inhibitors, acetaminophen), gabapentanoids, erectile dysfunction (ED) drugs, psychotropic drugs (tricyclic antidepressants [TCAs], monoamine oxidase inhibitors [MAOI], selective serotonin reuptake inhibitors [SSRIs], serotonin norepinephrine reuptake inhibitors [SNRIs], and cannabinol-containing drugs). In addition, the potential adverse drug-interactions between these chronic medications and commonly used anesthetic drugs during the perioperative period will be reviewed. Finally, recommendations regarding the management of chronic medications during the preoperative period will be provided.Materials and Methods: An online search was conducted from January 2000 through February 2021 with the Medline database through PubMed and Google Scholar using the following search terms/keywords: "chronic medications in the perioperative period", and "chronic medications and anesthetic implications." In addition, we searched for anesthetic side effects associated with the major drug groups.Results and Conclusions: An understanding of the pharmacodynamic effects of most used chronic medications is important to avoid untoward outcomes in the perioperative period. These drug interactions may result in altered efficacy and toxicity of the anesthetic medications administered during surgery. These drug-drug interactions can also affect the morbidity, mortality, recovery time of surgical patients and acute relapse of chronic illnesses which could lead to last minute cancellation of surgical procedures. Part II of this two-part review article focuses on the reported interactions between most commonly taken chronic medications by surgical patients and anesthetic and analgesic drugs, as well as recommendations regarding the handling these chronic medications during the perioperative period.
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Affiliation(s)
| | - Paul F White
- Department of Anesthesiology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.,The White Mountain Institute, The Sea Ranch, CA, USA
| | - Hillenn Cruz Eng
- Adena Health System, department of anesthesiology, Chillicothe, OH, US
| | - Firuz Yumul
- Department of family medicine, Skagit Regional Health, Family Medicine, Arlington, WA, USA
| | - Raissa Chua
- Department of Internal Medicine, Huntington Hospital, Prasadena, CA, USA
| | - Roya Yumul
- Department of Anesthesiology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.,David Geffen School of Medicine-UCLA, Charles R, Drew University of Medicine and Science, Los Angeles, CA, USA
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Elvir-Lazo OL, White PF, Cruz Eng H, Yumul F, Chua R, Yumul R. Impact of chronic medications in the perioperative period: mechanisms of action and adverse drug effects (Part I). Postgrad Med 2021; 133:939-952. [PMID: 34551662 DOI: 10.1080/00325481.2021.1982297] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Background: This review article discusses the pharmacology of the most commonly used chronic medications in patients undergoing elective surgical procedures. The mechanism of action and adverse side effects of cardiovascular medications (e.g., beta blockers, alpha-2 agonist, calcium channel blockers, ACE inhibitors, diuretics), lipid-lowering drugs, gastrointestinal medications (H2-blockers, proton pump inhibitors), pulmonary medications (inhaled β-agonists, anticholinergics,), antibiotics (tetracyclines, clindamycin and macrolide, linezolid), opioids and non-opioids analgesics (NSAIDs, COX-2 inhibitors, acetaminophen), gabapentanoids, erectile dysfunction (ED) drugs, and psychotropic drugs (tricyclic antidepressants [TCAs], monoamine oxidase inhibitors [MAOI], selective serotonin reuptake inhibitors [SSRIs], serotonin norepinephrine reuptake inhibitors [SNRIs], and cannabinol-containing drugs) will be reviewed.Materials and Methods: An online search was conducted from January 2000 through February 2021 with the Medline database through PubMed and Google Scholar using the following search terms/keywords: "chronic medications in the perioperative period", and "chronic medications and anesthetic implications." In addition, we searched for anesthetic side effects associated with the major drug groups.Results and Conclusions: An understanding of the pharmacology and pharmacokinetics of most used chronic medications is important to avoid untoward outcomes in the perioperative period. These drug interactions may result in altered efficacy and toxicity of the anesthetic medications administered during surgery. These drug-drug interactions can also effect the morbidity, mortality, and recovery time of surgical patients. Part I of this two-part review article focuses on the mechanisms of action and adverse side effects of the chronic medications most commonly taken by surgical patients in the preoperative period.
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Affiliation(s)
| | - Paul F White
- Department of Anesthesiology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.,The White Mountain Institute, The Sea Ranch, CA, USA
| | - Hillenn Cruz Eng
- Department of Anesthesiology, Adena Health System, Chillicothe, OH, USA
| | - Firuz Yumul
- Skagit Regional Health, Family Medicine, Arlington, WA, USA
| | - Raissa Chua
- Department of Internal Medicine, Huntington Hospital, Pasadena, CA, USA
| | - Roya Yumul
- Department of Anesthesiology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.,David Geffen School of Medicine-UCLA, Charles R, Drew University of Medicine and Science, Los Angeles, CA, USA
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Capuzzi E, Caldiroli A, Leo S, Buoli M, Clerici M. Initiation of psychotropic medication in hospitalized patients with COVID-19: Association with clinical and biological characteristics. Hum Psychopharmacol 2021; 36:e2789. [PMID: 33852168 PMCID: PMC8250257 DOI: 10.1002/hup.2789] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 03/19/2021] [Accepted: 03/22/2021] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Inpatients with coronavirus disease 2019 (COVID-19) show a high rate of neuropsychiatric manifestations, possibly related to a higher risk of serious illness or death. Use of psychotropic medications (PMs) indicates the presence of neuropsychiatric symptoms in COVID-19 patients. So far, potential clinical predictors of use of PMs have not been much investigated. In order to extend research in this area, we aimed to investigate the prevalence of PM prescription among a sample of inpatients with COVID-19 and to find potential predictors of initiation of PMs in these individuals. METHODS This is a cross-sectional single-center study, conducted during the first outbreak peak in a hospital of northern Italy. Information on socio-demographic characteristics, comorbidities, routine blood test, use of potential COVID-19 treatments, and length of stay were retrieved from medical records. RESULTS Data were available for 151 inpatients. Forty-seven of them (31.1%) started at least one prescription of a PM. PM prescription was significantly inversely associated with lymphocyte and platelet counts. A significant association was also found for lactate dehydrogenase (LDH). CONCLUSION Our findings suggest that the initiation of PMs could be common among COVID-19 inpatients. Lymphocyte and platelet counts as well as LDH levels may reflect neuropsychiatric complications of COVID-19.
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Affiliation(s)
- Enrico Capuzzi
- Psychiatric DepartmentAzienda Socio Sanitaria Territoriale MonzaMonzaItaly
| | - Alice Caldiroli
- Psychiatric DepartmentAzienda Socio Sanitaria Territoriale MonzaMonzaItaly
| | - Silvia Leo
- Department of Medicine and SurgeryUniversity of Milano BicoccaMonzaItaly
| | - Massimiliano Buoli
- Department of Neurosciences and Mental HealthFondazione IRCCS Ca'Granda Ospedale Maggiore PoliclinicoMilanItaly,Department of Pathophysiology and TransplantationUniversity of MilanMilanItaly
| | - Massimo Clerici
- Psychiatric DepartmentAzienda Socio Sanitaria Territoriale MonzaMonzaItaly,Department of Medicine and SurgeryUniversity of Milano BicoccaMonzaItaly
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15
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Ahmad A, Sheikh S, Khan MA, Chaturvedi A, Patel P, Patel R, Buch BC, Anand RS, Shah TC, Vora VN, Ramasubramanian V, Rao S, Kumar N, Prasad BSV, Sathianathan R, Verma KK, Jhanwar VG, Kumar N, Shah S, Dalal PK, Sindhu B, Talukdar P, Ahmad I. Endoxifen: A new, protein kinase C inhibitor to treat acute and mixed mania associated with bipolar I disorder. Bipolar Disord 2021; 23:595-603. [PMID: 33368969 DOI: 10.1111/bdi.13041] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 10/19/2020] [Accepted: 12/20/2020] [Indexed: 12/28/2022]
Abstract
OBJECTIVES Endoxifen is a protein kinase C inhibitor. The objective of the present phase III study was to demonstrate the safety and efficacy of endoxifen in treating bipolar I disorder (BPD I) patients. METHODS A multicenter, double-blind, active-controlled study was conducted using a daily dose of 8 mg endoxifen compared to 1000 mg divalproex, the current standard treatment, in patients with BPD I acute manic episodes with/without mixed features. The primary endpoint of our study was the mean change in total Young Mania Rating Scale (YMRS) score at day 21. RESULTS Endoxifen (n = 116) significantly (p < 0.0001) reduced total YMRS score (from 33.1 to 17.8. A significant (p < 0.001) improvement in Montgomery-Åsberg Depression Rating Scale (MADRS) score was observed for endoxifen (4.8 to 2.5). Early time to remission of the disease was observed with endoxifen compared to divalproex. None of the patients required rescue medication and there was no drug-associated withdrawals. Changes in Clinical Global Impressions-Bipolar Disorder and Clinical Global Impression-Severity of Illness scores showed that treatment with endoxifen was well-tolerated. CONCLUSIONS Endoxifen at a low daily dose of 8 mg was as efficacious and safe in patients with BPD I acute manic episodes with/without mixed features.
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Affiliation(s)
- Ateeq Ahmad
- Jina Pharmaceuticals Inc, Libertyville, IL, USA
| | | | | | | | - Piyush Patel
- Intas Pharmaceuticals Ltd, Ahmedabad, Gujarat, India
| | - Ronak Patel
- Lambda Therapeutic Research Ltd, Ahmedabad, Gujarat, India
| | | | | | | | | | | | | | - Narendra Kumar
- Mysore Medical College and Research Institute, K.R. Hospital, Mysore, Karnataka, India
| | - B S V Prasad
- Sujata Birla Hospital and Medical Research Center, Nasik, Maharashtra, India
| | | | | | - Venu Gopal Jhanwar
- Deva Institute of Healthcare and Research, Varanasi, Uttar Pradesh, India
| | - Nand Kumar
- All India Institute of Medical Sciences, New Delhi, India
| | - Sandip Shah
- Gujarat Medical Education & Research Society Medical College, Gotri, Vadodara, India
| | - Pronob Kumar Dalal
- King George's Medical University, G.M. Associated Hospitals, Lucknow, Uttar Pradesh, India
| | | | - Payel Talukdar
- Nil Ratan Sircar Medical College and Hospital, Kolkata, West Bengal, India
| | - Imran Ahmad
- Jina Pharmaceuticals Inc, Libertyville, IL, USA
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16
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Buoli M, Gattoni E, Collantoni E, Monteleone AM, Solmi M, Longo L, Ribolsi M, Santambrogio J, Bersani FS, Aguglia A, Serafini G, Signorelli MS, Dell'Osso B, Luciano M, Galderisi S. Factors influencing lithium versus valproate prescription preference in the maintenance treatment of bipolar patients: a report from the Italian Early Career Psychiatrists (SOPSI-GG). Int J Psychiatry Clin Pract 2021; 25:82-89. [PMID: 33380246 DOI: 10.1080/13651501.2020.1865405] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Objective of the present manuscript is to investigate, among Italian early career psychiatrists (ECPs), prescriber and patient-related factors associated with lithium or valproate preference to treat patients affected by Bipolar Disorder (BD). METHODS An on-line survey was carried out among 252 ECPs, investigating their prescription patterns in relation to lithium and the differences with prescription of valproate. Collected data were compared according to lithium or valproate prescription preference in the long-term treatment of BD by χ2 tests for qualitative variables. RESULTS Over two thirds of ECPs preferred lithium over valproate for the maintenance treatment of BD. Less than half of the sample used lithium as first-line agent for mania or major depression, and less than one third for mixed episodes. Factors associated with lithium preference as first-line maintenance treatment include perception of having a good knowledge of lithium (p < 0.001) and complete satisfaction with education on lithium (p < 0.001). One of the main factors to prefer valproate was the concern about long-term side effects of lithium (p < 0.001). CONCLUSIONS Type of education, source of information, clinical experience and safety concerns influence the choice of lithium versus valproate in the long-term treatment of BD. Present findings may guide educational training of ECPs.KEY POINTSLithium has been less prescribed in the last years for long-term treatment of Bipolar Disorder.Educational and clinical factors seem to influence the attitude to prescribe lithium.Only half of the Italian early career psychiatrists declare to have at least an adequate knowledge of lithium.Residency program in psychiatry should consider the implementation of education on lithium.
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Affiliation(s)
- Massimiliano Buoli
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Eleonora Gattoni
- Department of Translational Medicine, Institute of Psychiatry, Università del Piemonte Orientale, Novara, Italy.,Institute of Psychiatry, Maggiore della Carità Hospital of Novara, Novara, Italy
| | | | - Alessio Maria Monteleone
- Department of Psychiatry, University of Campania "L. Vanvitelli", Largo Madonna Delle Grazie, Naples, Italy
| | - Marco Solmi
- Neurosciences Department, University of Padua, Padua, Italy
| | - Luisa Longo
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari Aldo Moro, Bari, Italy; Azienda Ospedaliero-Universitaria Consorziale Policlinico, Bari, Italy
| | | | - Jacopo Santambrogio
- Department of Medicine and Surgery, School of Medicine and Surgery, University of Milano Bicocca, Milan, Italy
| | | | - Andrea Aguglia
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Gianluca Serafini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Maria Salvina Signorelli
- Department of Clinical and Experimental Medicine, AOU Policlinico Hospital, University of Catania, Catania, Italy
| | - Bernardo Dell'Osso
- Department of Biomedical and Clinical Sciences, "Luigi Sacco", Psychiatry Unit 2, ASST-Fatebenefratelli-Sacco, Milan, Italy.,Department of Psychiatry and Behavioral Sciences, Bipolar Disorders Clinic, Stanford University, Stanford, CA, USA.,CRC "Aldo Ravelli" for Neurotechnology and Experimental Brain Therapeutics University of Milan, Milan, Italy
| | - Mario Luciano
- Department of Psychiatry, University of Campania "L. Vanvitelli", Largo Madonna Delle Grazie, Naples, Italy
| | - Silvana Galderisi
- Department of Psychiatry, University of Campania "L. Vanvitelli", Largo Madonna Delle Grazie, Naples, Italy
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Heidemann J, Schmitz B, Kostev K. Association between antiseizure medication use and risk of urinary tract infection: A case-control study. Epilepsy Behav 2021; 115:107502. [PMID: 33323337 DOI: 10.1016/j.yebeh.2020.107502] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 08/31/2020] [Accepted: 09/11/2020] [Indexed: 12/23/2022]
Abstract
AIM The aim of this study was to analyze the association between antiseizure medication (ASM) and the risk of urinary tract infections (UTI) in patients with epilepsy treated in general practices in Germany. METHODS This study includes a total of 2201 patients (mean age: 61.4) whose first documented UTI diagnosis occurred between January 2015 and December 2019 (index date) and who were prescribed at least one ASM in 1198 general practices in Germany within one year prior to the index date. Based on a case-control design, the association between predefined criteria and UTI was investigated by matching (1:1) controls without UTI to cases with UTI by sex, age, and codiagnoses. Logistic regression models were used to analyze the association between ASM use and UTI risk. RESULTS In the first regression model, phenytoin (PHT), primidone, carbamazepine (CBZ), and valproate (VPA) were associated with an increased risk of UTI. In the second model, these associations were confirmed with effects per prescription for PHT, primidone, CBZ, and VPA use. Additionally, the effect per prescription was significant for oxcarbazepine (OXC), topiramate, and gabapentin. CONCLUSION The study found that PHT, primidone, CBZ, and VPA in particular are associated with an increased risk of infections of the urinary tract. Oxcarbazepine, topiramate, and gabapentin are also associated with increased risk of UTI, albeit to a less significant extent. In general, the immunological and hematological side effects of these molecules may play an important role in the development of UTI under anticonvulsant therapy.
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Affiliation(s)
| | - Bettina Schmitz
- Department of Neurology, Vivantes Humboldt-Klinikum, Berlin, Germany
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18
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Clinically Significant Drug Interactions Between Psychotropic Agents and Repurposed COVID-19 Therapies. CNS Drugs 2021; 35:345-384. [PMID: 33866523 PMCID: PMC8053373 DOI: 10.1007/s40263-021-00811-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/26/2021] [Indexed: 02/07/2023]
Abstract
As many patients with underlying psychiatric disorders may be infected with COVID-19, and COVID-19-affected subjects may frequently experience a new onset of psychiatric manifestations, concomitant use of psychotropic medications and COVID-19 therapies is expected to be highly likely and raises concerns of clinically relevant drug interactions. In this setting, four major mechanisms responsible for drug interactions involving psychotropic agents and COVID-19 therapies may be identified: (1) pharmacokinetic drug-drug interactions mainly acting on cytochrome P450; (2) pharmacodynamic drug-drug interactions resulting in additive or synergistic toxicity; (3) drug-disease interactions according to stage and severity of the disease; and (4) pharmacogenetic issues associated with polymorphisms of cytochrome P450 isoenzymes. In this review, we summarise the available literature on relevant drug interactions between psychotropic agents and COVID-19 therapies, providing practical clinical recommendations and potential management strategies according to severity of illness and clinical scenario.
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19
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Evaluation of the effects of antiepileptic drugs on complete blood count parameters. JOURNAL OF SURGERY AND MEDICINE 2020. [DOI: 10.28982/josam.827657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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20
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Wahba A, Bergez E. Severe Pancytopenia Induced by Valproic Acid. Cureus 2020; 12:e11252. [PMID: 33269170 PMCID: PMC7707128 DOI: 10.7759/cureus.11252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Valproic acid is commonly used to treat pediatric epilepsy. This drug is usually well-tolerated; its side effects are typically mild, with hepatotoxicity being the most widely recognized one. Bone marrow suppression is a rarely seen complication in patients with valproic acid levels more than 125 mcg/mL. Reported cases indicate an increased incidence of hematologic toxicity; however, evidence for management is limited. We report a case of bone marrow suppression induced by a high dose of valproic acid in a 10-year-old male.
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Affiliation(s)
- Andrew Wahba
- Pediatrics, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, USA
| | - Emmalee Bergez
- Pediatrics, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, USA
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21
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Rudà R, Houillier C, Maschio M, Reijneveld JC, Hellot S, De Backer M, Chan J, Joeres L, Leunikava I, Glas M, Grant R. Effectiveness and tolerability of lacosamide as add-on therapy in patients with brain tumor-related epilepsy: Results from a prospective, noninterventional study in European clinical practice (VIBES). Epilepsia 2020; 61:647-656. [PMID: 32329527 PMCID: PMC7384112 DOI: 10.1111/epi.16486] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 02/26/2020] [Accepted: 03/02/2020] [Indexed: 12/22/2022]
Abstract
Objective To evaluate the effectiveness and tolerability of lacosamide added to one or two antiepileptic drugs (AEDs) in the treatment of patients with brain tumor–related epilepsy (BTRE), and to evaluate patients’ global impression of change and quality of life (QoL). Methods This was a prospective, multicenter, single‐arm, noninterventional study with a 6‐month observation period (EP0045; NCT02276053). Eligible patients (≥16 years old) had active BTRE secondary to low‐grade glioma (World Health Organization grade 1 and 2) and were receiving treatment with one or two AEDs at baseline. Lacosamide was initiated by the treating physician in the course of routine clinical practice. Primary outcomes were 50% responders (≥50% reduction in focal seizure frequency from baseline) and Patient's Global Impression of Change (PGIC) at month 6. Secondary outcomes included seizure‐free status and Clinical Global Impression of Change (CGIC) at month 6, change in QoL (5‐Level EuroQol‐5 Dimension Quality of Life Assessment) and symptom outcomes (MD Anderson Symptom Inventory–Brain Tumor) from baseline to month 6, and Kaplan‐Meier estimated 6‐month retention on lacosamide. Safety variables included adverse drug reactions (ADRs). Results Patients were recruited from 24 sites in Europe. Ninety‐three patients received lacosamide (mean [standard deviation] age = 44.5 [14.7] years; 50 [53.8%] male; median baseline focal seizure frequency = five seizures/28 days [range = 1‐280]), of whom 79 (84.9%) completed the study. At 6 months, 66 of 86 (76.7%) patients were 50% responders and 30 of 86 (34.9%) were seizure‐free. Improvements on PGIC were reported by 49 of 76 (64.5%) patients. Based on CGIC, 52 of 81 (64.2%) patients improved. QoL and symptoms outcome measures remained stable. Kaplan‐Meier estimated 6‐month retention rate was 86.0% (N = 93). Fifteen (16.1%) patients reported ADRs; four (4.3%) had ADRs leading to discontinuation (N = 93). Significance Results of this prospective, noninterventional study suggest that add‐on lacosamide is effective and generally well tolerated in patients with BTRE.
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Affiliation(s)
- Roberta Rudà
- Department of Neuro-Oncology, City of Health and Science and University of Turin, Turin, Italy
| | - Caroline Houillier
- AP-HP, Sorbonne Université, IHU, ICM, Public Hospital Network of Paris, Service de Neurologie 2-Mazarin, Hôpitaux, Universitaires La Pitié Salpêtrière - Charles Foix, Paris, France
| | - Marta Maschio
- Center for Tumor-Related Epilepsy, UOSD Neuro-Oncology IRCCS, Regina Elena National Cancer Institute, Rome, Italy
| | - Jaap C Reijneveld
- Amsterdam UMC, Amsterdam, The Netherlands.,Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, The Netherlands
| | | | | | | | | | | | - Martin Glas
- Division of Clinical Neuro-oncology, Department of Neurology, West German Cancer Center and German Cancer Consortium Partner Site, Essen University Hospital, University of Duisburg-Essen, Essen, Germany
| | - Robin Grant
- Department of Clinical Neurosciences, Royal Infirmary of Edinburgh, Edinburgh, UK
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Orsolini L, Pompili S, Volpe U. The ‘collateral side’ of mood stabilizers: safety and evidence-based strategies for managing side effects. Expert Opin Drug Saf 2020; 19:1461-1495. [DOI: 10.1080/14740338.2020.1820984] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Laura Orsolini
- Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
- Unit of Clinical Psychiatry, Department of Neurosciences/DIMSC, Polytechnic University of Marche, Ancona, Italy
| | - Simone Pompili
- Unit of Clinical Psychiatry, Department of Neurosciences/DIMSC, Polytechnic University of Marche, Ancona, Italy
| | - Umberto Volpe
- Unit of Clinical Psychiatry, Department of Neurosciences/DIMSC, Polytechnic University of Marche, Ancona, Italy
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23
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Safety range of free valproic acid serum concentration in adult patients. PLoS One 2020; 15:e0238201. [PMID: 32877431 PMCID: PMC7467252 DOI: 10.1371/journal.pone.0238201] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Accepted: 08/11/2020] [Indexed: 01/09/2023] Open
Abstract
Background Therapeutic drug monitoring (TDM) is recommended during valproic acid (VPA) use, and total serum concentration has been widely adopted. However, the free form of VPA is responsible for its pharmacologic and toxic effects, and the total and free concentrations are highly discordant because of VPA’s highly protein bound and saturable binding characteristics. Therefore, free VPA monitoring is increasingly advocated. Nevertheless, the correlation between free VPA concentration and associated adverse effects remains unknown. Objective To determine the optimal safety range of free VPA concentration in adult patients. Materials and methods This prospective cohort study enrolled adult patients undergoing VPA therapy with TDM. Patient characteristics, VPA use, and adverse effects (thrombocytopenia, hyperammonemia, and hepatotoxicity) were recorded. A multivariate logistic regression model was applied to identify the predictors of adverse effects, and the receiver operating characteristic curve was applied to locate the cutoff point of free VPA concentration. Results A total of 98 free serum concentrations from 51 patients were included for final analysis. In total, 31 (31.6%), 27 (27.6%), and 4 (4.1%) episodes of hyperammonemia, thrombocytopenia, and hepatotoxicity were observed, respectively. Free VPA concentration was a predicting factor for thrombocytopenia but not for hyperammonemia. A free VPA concentration of >14.67 mcg/mL had the greatest discriminating power (area under the curve = 0.77) for the occurrence of thrombocytopenia. Conclusions A free VPA serum concentration of 14.67 mcg/mL had the optimal discriminating power for the occurrence of thrombocytopenia. Ammonemia should be monitored even if free VPA concentration is within the safety range.
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Benlachgar N, Doghmi K, Masrar A, Mahtat EM, Harmouche H, Tazi Mezalek Z. Immature platelets: a review of the available evidence. Thromb Res 2020; 195:43-50. [PMID: 32652352 DOI: 10.1016/j.thromres.2020.06.048] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 05/12/2020] [Accepted: 06/30/2020] [Indexed: 12/28/2022]
Abstract
Immature platelets or reticulated platelets are newly released thrombocytes. They can be identified by their large size and high RNA cytoplasm concentration. Immature platelet fraction (IPF) represents the percentage of immature circulative platelets to the total number of platelets. The development of analytical standardization of this hematological parameter by new automated devices allowed a better exploration of its contribution in a context of thrombocytopenia. In fact, several studies had confirmed its clinical utility to differentiate immune thrombocytopenia from other causes of thrombocytopenia. IPF can also predict platelets recovery after chemotherapy and successful engraftment. In addition, immature platelets have shown utility in other diseases such as coronary artery diseases, bacterial infections and liver diseases. Despite all these advantages, immature platelet fraction can be increased in some cases of thrombocytopenia characterized by platelets hypoproduction. The aim of this review is to present the immature platelet fraction contribution in clinical practice.
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Affiliation(s)
- Naoufal Benlachgar
- Department of Clinical Haematology, Military Hospital of Instruction Mohamed V, Rabat, Morocco.
| | - Kamal Doghmi
- Department of Clinical Haematology, Military Hospital of Instruction Mohamed V, Rabat, Morocco
| | - Azlarab Masrar
- Central laboratory of hematology, Ibn Sina Hospital, University Mohamed V of Medicine, Rue Lamfadel Cherkaoui, BP 6527 Rabat, Morocco
| | - El Mehdi Mahtat
- Department of Clinical Haematology, Military Hospital of Instruction Mohamed V, Rabat, Morocco
| | - Hicham Harmouche
- Internal Medicine Department, Ibn Sina Hospital, University Mohamed V of Medicine, Rue Lamfadel Cherkaoui, BP 6527 Rabat, Morocco
| | - Zoubida Tazi Mezalek
- Internal Medicine Department, Ibn Sina Hospital, University Mohamed V of Medicine, Rue Lamfadel Cherkaoui, BP 6527 Rabat, Morocco
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25
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Deschenes PC, Autmizguine J, Major P, Kleiber N. Valproic Acid Induced Pancreatitis Presenting With Decreased Level of Consciousness in a Child With Tuberous Sclerosis Complex. J Pediatr Pharmacol Ther 2020; 25:256-260. [PMID: 32265611 DOI: 10.5863/1551-6776-25.3.256] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
A 2-year-old Caucasian boy with tuberous sclerosis complex presented to the emergency department with lethargy and new onset myoclonias. Pancreatitis, thrombocytopenia, and coagulopathy associated to a decreased level of consciousness were diagnosed. Valproic acid had been initiated 13 months before and had been slowly increased to a dose of approximately 38 mg/kg/day. All the symptoms resolved after discontinuation of the medication. The clinical presentation of this child highlights that valproic acid-related pancreatitis can present with decreased level of consciousness without associated gastrointestinal symptoms. Adverse drug reactions associated with valproic acid can lead to damage of multiple organs and may prove fatal if not promptly recognized and managed.
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26
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Choi SA, Kim H, Kim S, Yoo S, Yi S, Jeon Y, Hwang H, Kim KJ. Analysis of antiseizure drug-related adverse reactions from the electronic health record using the common data model. Epilepsia 2020; 61:610-616. [PMID: 32162687 DOI: 10.1111/epi.16472] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 01/27/2020] [Accepted: 02/18/2020] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Antiseizure drugs (ASDs) are known to cause a wide range of adverse drug reactions (ADRs). Recently, electronic health care data using the common data model (CDM) have been introduced and commonly adopted in pharmacovigilance research. We aimed to analyze ASD-related ADRs using CDM and to assess the feasibility of CDM analysis in monitoring ADR in a single tertiary hospital. METHODS We selected five ASDs: oxcarbazepine (OXC), lamotrigine (LTG), levetiracetam (LEV), valproic acid (VPA), and topiramate (TPM). Patients diagnosed with epilepsy and exposed to monotherapy with one of the ASDs before age 18 years were included. We measured four ADR outcomes: (1) hematologic abnormality, (2) hyponatremia, (3) elevation of liver enzymes, and (4) subclinical hypothyroidism. We performed a subgroup analysis to exclude the effects of concomitant medications. RESULTS From the database, 1344 patients were included for the study. Of the 1344 patients, 436 were receiving OXC, 293 were receiving LTG, 275 were receiving LEV, 180 were receiving VPA, and 160 were receiving TPM. Thrombocytopenia developed in 14.1% of patients taking VPA. Hyponatremia occurred in 10.5% of patients taking OXC. Variable ranges of liver enzyme elevation were detected in 19.3% of patients taking VPA. Subclinical hypothyroidism occurred in approximately 21.5% to 28% of patients with ASD monotherapy, which did not significantly differ according to the type of ASD. In a subgroup analysis, we observed similar ADR tendencies, but with less thrombocytopenia in the TPM group. SIGNIFICANCE The incidence and trends of ADRs that were evaluated by CDM were similar to the previous literature. CDM can be a useful tool for analyzing ASD-related ADRs in a multicenter study. The strengths and limitations of CDM should be carefully addressed.
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Affiliation(s)
- Sun Ah Choi
- Department of Pediatrics, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.,Department of Pediatrics, Dankook University Hospital, Dankook University College of Medicine, Cheonan, Korea
| | - Hunmin Kim
- Department of Pediatrics, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Seok Kim
- Office of eHealth Research and Business, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sooyoung Yoo
- Office of eHealth Research and Business, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Soyoung Yi
- Office of eHealth Research and Business, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Yonghoon Jeon
- Office of eHealth Research and Business, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hee Hwang
- Department of Pediatrics, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.,Office of eHealth Research and Business, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Ki Joong Kim
- Departement of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea
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Kopeikina E, Dukhinova M, Yung AWY, Veremeyko T, Kuznetsova IS, Lau TYB, Levchuk K, Ponomarev ED. Platelets promote epileptic seizures by modulating brain serotonin level, enhancing neuronal electric activity, and contributing to neuroinflammation and oxidative stress. Prog Neurobiol 2020; 188:101783. [PMID: 32142857 DOI: 10.1016/j.pneurobio.2020.101783] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 02/04/2020] [Accepted: 02/24/2020] [Indexed: 11/28/2022]
Abstract
The drugs currently available for treating epilepsy are only partially effective in managing this condition. Therefore, it is crucial to investigate new pathways that induce and promote epilepsy development. Previously, we found that platelets interact with neuronal glycolipids and actively secrete pro-inflammatory mediators during central nervous system (CNS) pathological conditions such as neuroinflammation and traumatic brain injury (TBI). These factors increase the permeability of the blood-brain barrier (BBB), which may create a predisposition to epileptic seizures. In this study, we demonstrated that platelets substantially enhanced epileptic seizures in a mouse model of pentylenetetrazole (PTZ) -induced seizures. We found that platelets actively secreted serotonin, contributed to increased BBB permeability, and were present in the CNS parenchyma during epileptic seizures. Furthermore, platelets directly stimulated neuronal electric activity and induced the expression of specific genes related to early neuronal response, neuroinflammation, and oxidative phosphorylation, leading to oxidative stress in neurons. The intracranial injection of physiological numbers of platelets that mimicked TBI-associated bleeding was sufficient to induce severe seizures, which resembled conventional PTZ-induced epileptic activity. These findings highlight a conceptually new role of platelets in the development of epileptic seizures, and indicate a potential new therapeutic approach targeting platelets to prevent and treat epilepsy.
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Affiliation(s)
- Ekaterina Kopeikina
- School of Biomedical Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, NT, Hong Kong
| | - Marina Dukhinova
- School of Biomedical Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, NT, Hong Kong
| | - Amanda W Y Yung
- School of Biomedical Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, NT, Hong Kong
| | - Tatyana Veremeyko
- School of Biomedical Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, NT, Hong Kong
| | - Inna S Kuznetsova
- School of Biomedical Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, NT, Hong Kong
| | - Thomas Y B Lau
- School of Biomedical Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, NT, Hong Kong
| | - Kseniia Levchuk
- School of Biomedical Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, NT, Hong Kong
| | - Eugene D Ponomarev
- School of Biomedical Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, NT, Hong Kong.
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Kim DW, Kim W, Lee CH, Chun YI. Thrombocytopenia during intravenous valproic acid therapy in the neurological intensive care unit. J Clin Pharm Ther 2020; 45:1014-1020. [PMID: 32040242 DOI: 10.1111/jcpt.13125] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 12/17/2019] [Accepted: 01/07/2020] [Indexed: 11/30/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE 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. METHODS 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. RESULTS 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 × 109 /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. WHAT IS NEW AND CONCLUSION 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.
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Affiliation(s)
- Dong Wook Kim
- Department of Neurology, Konkuk University School of Medicine, Seoul, South Korea
| | - Wonshik Kim
- Department of Neurology, Konkuk University School of Medicine, Seoul, South Korea
| | - Chang-Hoon Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Young Il Chun
- Department of Neurosurgery, Konkuk University School of Medicine, Seoul, South Korea
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Park A, Shapiro B, Hedayati B, Faziola L. Case of significantly delayed divalproex-induced thrombocytopaenia. BMJ Case Rep 2019; 12:12/12/e231968. [PMID: 31796434 DOI: 10.1136/bcr-2019-231968] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
We describe a 48-year-old male patient on long-term divalproex treatment for bipolar disorder who developed grade II thrombocytopaenia after approximately 18 years of therapy. Abrupt cessation of divalproex led to immediate platelet level reconstitution.
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Affiliation(s)
- Andrew Park
- Psychiatry and Human Behavior, UC Irvine Medical Center, Orange, California, USA
| | - Bryan Shapiro
- Psychiatry and Human Behavior, UC Irvine Medical Center, Orange, California, USA
| | - Bobak Hedayati
- Psychiatry and Human Behavior, UC Irvine Medical Center, Orange, California, USA
| | - Lawrence Faziola
- Psychiatry, Department of Veterans Affairs, Long Beach, Long Beach, California, USA
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Wang CL, Wu VCC, Chang KH, Tu HT, Kuo CF, Huang YT, Chu PH, Kuo CC, Chang SH. Assessing major bleeding risk in atrial fibrillation patients concurrently taking non-vitamin K antagonist oral anticoagulants and antiepileptic drugs. EUROPEAN HEART JOURNAL. CARDIOVASCULAR PHARMACOTHERAPY 2019; 6:147-154. [DOI: 10.1093/ehjcvp/pvz035] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 07/12/2019] [Accepted: 08/01/2019] [Indexed: 01/16/2023]
Abstract
Abstract
Aims
This study compared the risk of major bleeding between atrial fibrillation (AF) patients who took non-vitamin K antagonist oral anticoagulants (NOACs) and antiepileptic drugs (AEDs) concurrently and those who took only NOACs.
Methods and results
We performed a retrospective cohort study using Taiwan National Health Insurance database and included AF patients who received NOAC prescriptions from 1 June 2012 to 31 December 2017. The major bleeding risks of person-quarters exposed to NOAC and 11 concurrent AEDs (carbamazepine, gabapentin, lamotrigine, levetiracetam, oxcarbazepine, phenobarbital, phenytoin, pregabalin, topiramate, valproic acid, and zonisamide) were compared with person-quarters exposed to NOAC alone. Adjusted incidence rate differences between NOAC with or without concurrent AEDs were estimated using Poisson regression models weighted by the inverse probability of treatment. Among 104 319 patients (age 75.0 ± 10.3 years; men, 56.2%), 8546 major bleeding events occurred during 731 723 person-quarters with NOAC prescriptions. Concurrent AED use was found in 15.3% of NOAC-treated patients. Concurrent use of NOAC with valproic acid, phenytoin, or levetiracetam increased adjusted incidence rates per 1000 person-years of major bleeding more significantly than NOAC alone: 153.49 for NOAC plus valproic acid vs. 55.06 for NOAC alone [difference 98.43, 95% confidence interval (CI) 82.37–114.49]; 135.83 for NOAC plus phenytoin vs. 54.43 for NOAC alone (difference 81.4, 95% CI 60.14–102.66); and 132.96 for NOAC plus levetiracetam vs. 53.08 for NOAC alone (difference 79.88, 95% CI 64.47–95.30).
Conclusion
For AF patients, the concurrent use of NOACs and valproic acid, phenytoin, or levetiracetam was associated with a higher risk of major bleeding.
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Affiliation(s)
- Chun-Li Wang
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou Medical Center, No. 5, Fushin St. Kweishan District, 33305 Taoyuan City, Taiwan
- College of Medicine, Chang Gung University, No. 259, Wenhua 1st Road, Kweishan District, 33302 Taoyuan City, Taiwan
| | - Victor Chien-Chia Wu
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou Medical Center, No. 5, Fushin St. Kweishan District, 33305 Taoyuan City, Taiwan
- College of Medicine, Chang Gung University, No. 259, Wenhua 1st Road, Kweishan District, 33302 Taoyuan City, Taiwan
| | - Kuo-Hsuan Chang
- College of Medicine, Chang Gung University, No. 259, Wenhua 1st Road, Kweishan District, 33302 Taoyuan City, Taiwan
- Department of Neurology, Chang Gung Memorial Hospital, Linkou Medical Center, No. 5, Fushin St. Kweishan District, 33305 Taoyuan City, Taiwan
| | - Hui-Tzu Tu
- Center for Big Data Analytics and Statistics, Chang Gung Memorial Hospital, Linkou Medical Center, No. 5, Fushin St. Kweishan District, 33305 Taoyuan City, Taiwan
| | - Chang-Fu Kuo
- College of Medicine, Chang Gung University, No. 259, Wenhua 1st Road, Kweishan District, 33302 Taoyuan City, Taiwan
- Division of Rheumatology, Allergy and Immunology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou Medical Center, No. 5, Fushin St. Kweishan District, 33305 Taoyuan City, Taiwan
- Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK
| | - Yu-Tung Huang
- Center for Big Data Analytics and Statistics, Chang Gung Memorial Hospital, Linkou Medical Center, No. 5, Fushin St. Kweishan District, 33305 Taoyuan City, Taiwan
- Graduate Institute of Nursing, Chang Gung University of Science and Technology, No. 261, Wenhua 1st Road, Kweishan District, 33302 Taoyuan City, Taiwan
| | - Pao-Hsien Chu
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou Medical Center, No. 5, Fushin St. Kweishan District, 33305 Taoyuan City, Taiwan
- College of Medicine, Chang Gung University, No. 259, Wenhua 1st Road, Kweishan District, 33302 Taoyuan City, Taiwan
| | - Chi-Ching Kuo
- Institute of Organic and Polymeric Materials, National Taipei University of Technology, No. 1, Section 3, Zhongxiao E Rd, Da-an District, 10607 Taipei, Taiwan
| | - Shang-Hung Chang
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou Medical Center, No. 5, Fushin St. Kweishan District, 33305 Taoyuan City, Taiwan
- College of Medicine, Chang Gung University, No. 259, Wenhua 1st Road, Kweishan District, 33302 Taoyuan City, Taiwan
- Center for Big Data Analytics and Statistics, Chang Gung Memorial Hospital, Linkou Medical Center, No. 5, Fushin St. Kweishan District, 33305 Taoyuan City, Taiwan
- Graduate Institute of Nursing, Chang Gung University of Science and Technology, No. 261, Wenhua 1st Road, Kweishan District, 33302 Taoyuan City, Taiwan
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Nakashima T, Tanaka T, Koido K, Nishibuchi Y, Hashimoto H, Ito A, Inamoto Y, Kurosawa S, Kim SW, Fukuda T, Terakado H. Comparison of valproate and levetiracetam for the prevention of busulfan-induced seizures in hematopoietic stem cell transplantation. Int J Hematol 2019; 109:694-699. [DOI: 10.1007/s12185-019-02637-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 03/15/2019] [Accepted: 03/17/2019] [Indexed: 12/13/2022]
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Abstract
Childhood absence epilepsy (CAE) is a common pediatric epilepsy syndrome with distinct seizure semiology, electroencephalography (EEG) features, and treatment. A diagnosis of CAE can be obtained during an office visit with a careful history, physical exam including prolonged hyperventilation, and a routine EEG. The treatment of choice for CAE with absence seizures only is ethosuximide. Valproic acid and lamotrigine are also effective treatments for many patients, but when compared to ethosuximide, valproic acid has more adverse effects and lamotrigine is less effective. Attention to predictors of response to treatment, including clinical, electrographic, and genetic factors, is increasing. Refractory CAE occurs in fewer than half of patients, and treatment strategies are available, though efficacy data are lacking. Careful assessment and treatment of psychosocial comorbidities is essential in caring for patients with CAE.
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Affiliation(s)
- Sudha Kilaru Kessler
- Perelman School of Medicine, Children’s Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA USA
| | - Emily McGinnis
- Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA USA
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Lee JS, Oh JS, Hong S, Lee CK, Yoo B, Kim YG. Tocilizumab-induced Thrombocytopenia in Patients with Rheumatoid Arthritis. JOURNAL OF RHEUMATIC DISEASES 2019. [DOI: 10.4078/jrd.2019.26.3.186] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- Jung Sun Lee
- Division of Rheumatology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Ji Seon Oh
- Department of Biomedical Informatics, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Seokchan Hong
- Division of Rheumatology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Chang-Keun Lee
- Division of Rheumatology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Bin Yoo
- Division of Rheumatology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Yong-Gil Kim
- Division of Rheumatology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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