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Valproate‐Associated Coagulopathies Are Frequent and Variable in Children

Dear Editors: We read with interest the article by Gerstner et al., (2006) entitled “Valproate-associated coagulopathies are frequent and variable in children.” The authors retrospectively reported 15 children with valproic acid (VPA)related coagulation problems. The clinical relevance of VPA-induced coagulopathies remains unclear. The authors concluded that, at this time, controlling all hemostatic parameters cannot be recommended in every patient, but only whenever an increased bleeding tendency is observed or before surgical procedures. We have recently studied prospectively, for a period up to 2 years, 30 ambulatory children (15 males, 15 females, mean age = 9.03 ± 3.69 years) that were treated for epilepsy with VPA monotherapy. Platelet count, international normalized ratio (INR), prothrombin time (PT) and activated partial thromboplastin time (aPTT) were measured before and at 6, 12 and 24 months of VPA treatment. All children had normal platelet count, INR, PT and aPTT values before the initiation of therapy. VPA concentrations remained within the therapeutic range (50–100 mg/L) during the study period. Platelet count was significantly decreased at 6, 12 and 24 months of treatment. INR was significantly increased at 12 and 24 months, PT was significantly increased at 24 months, while aPTT was significantly increased at 6 months of VPA monotherapy (Table 1). Significant association was found between INR and aPTT at 24 months of treatment (Pearson’s correlation coefficient, r = 0.753, p = 0.000). One (3.3%) child at 6 months and 2 (6.6%) children at 12 and 24 months of treatment had platelet count below the lower reference limit. Two (6.6%) children at 6 and 12 months and 3 (10%) children at 24 months of treatment had INR values higher