Valproic acid-associated low fibrinogen and delayed intracranial hemorrhage: case report and mini literature review

Figures & data

Figure 1 Image after second surgery. Head CT axial image shows the drainage tube placed in the lesion.

Abbreviation: CT, computed tomography.

Table 1 Literature on valproic acid (VPA)-associated hypofibrinogenemia

Study	Year	Research type	Hypofibrinogenemia patients, n/N	VPA dose, mg/kg/d*	Mean level of Fbg, g/L (nadir)	Hypofibrinogenemia-associated clinical bleeding	Discontinuation of therapy
Serdaroglu^Citation14	2002	Retrospective	8/29	20–30	2.40 (1.39)	No	No
Gerstner^Citation4	2006	Retrospective	5/385	20–130 mg/mLa	NA	No	Nob
Anderson^Citation15	2003	Prospective	0/75	40–100 mg/mLa	NA	No	No
Tokuda^Citation16	1994	Retrospective	3/3	59.7 mg/mLa,c	0.46 (0.22)	No	NA
Hauser^Citation17	1996	Prospective	NA/50	20–27	1.92 (0.76)	No	NA
Koenig^Citation10	2008	Prospective	12/23	70–120 mg/mLa	1.51 (NA)	No	No
Köse^Citation12	2009	Prospective	2/24	20d	1.89 (0.88)	No	No
Eberl^Citation18	2009	Prospective	9/40	NA	2.22 (NA)	No	No
Topf^Citation19	2011	Comparison study	NA/40	NA	NAe	No	No

Notes:

* Unless otherwise indicated.

a Serum level of;

b fibrinogen increased after VPA dosage reduction or discontinuation;

c combination of ACTH-Zn (adrenocorticotrophinzinc phosphate) and VPA;

d started at dose of 10 mg/kg/d (a week later the dose was raised to target dose);

e patients in the VPA group had lower hypofibrinogenemia than those in the control group (P < 0.05).

Abbreviations: Fbg, fibrinogen; NA, not available.

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