Thrombocytopenia during intravenous valproic acid therapy in the neurological intensive care unit
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 st...
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| Veröffentlicht in: | Journal of clinical pharmacy and therapeutics 2020-10, Vol.45 (5), p.1014-1020 |
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| creator | Kim, Dong Wook Kim, Wonshik Lee, Chang‐Hoon Chun, Young Il |
| description | 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 ( |
| doi_str_mv | 10.1111/jcpt.13125 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2353008842</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2440608072</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3935-bdba67443d3cb72334bfeee26831bbc76fd8bfc037991ee054048bbba38439743</originalsourceid><addsrcrecordid>eNp9kE1v1DAQhq2qiG4LF34AitQLQko7_kicHKtVoaBKcFjOlu1MWq-ydmoni_bf43RbDhyYi-fw-NU7DyEfKFzRPNdbO05XlFNWnZAV5XVVMknhlKyA1W0pJJNn5DylLQDUkvG35IwzEMAEWxG9eYxhZ4I9TGFE73TRzdH5h8L5Keo9-jCnYq-HMQZnC21dV0yPGPV4yMSyFh7nGIbw4Kwell_ok9tjYXXEYvZuekfe9HpI-P7lvSC_vtxu1nfl_Y-v39Y396XlLa9K0xldSyF4x63JLbkwPSKyuuHUGCvrvmtMb4HLtqWIUAkQjTFG80bwVgp-QT4dc3PVpxnTpHYuWRwG7TEfoRivOEDTCJbRy3_QbZijz-0UEwJqaEAu1OcjZWNIKWKvxuh2Oh4UBbWIV4t49Sw-wx9fImezw-4v-mo6A_QI_HYDHv4Tpb6vf26OoX8A8oaO7g</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2440608072</pqid></control><display><type>article</type><title>Thrombocytopenia during intravenous valproic acid therapy in the neurological intensive care unit</title><source>Wiley Online Library Journals Frontfile Complete</source><creator>Kim, Dong Wook ; Kim, Wonshik ; Lee, Chang‐Hoon ; Chun, Young Il</creator><creatorcontrib>Kim, Dong Wook ; Kim, Wonshik ; Lee, Chang‐Hoon ; Chun, Young Il</creatorcontrib><description>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.
The lower baseline platelet count (<200 × 109/L, OR: 17.25, 95% CI: [7.70‐37.76]), use of VPA for more than 3 days (OR: 3.80, 95% CI: [1.71‐8.43]), aetiologies other than intracranial haemorrhage or subarachnoid haemorrhage (OR: 2.67, 95% CI: [1.40‐5.09]) and infection (OR: 4.20, 95% CI: [1.95‐9.07])were found as independent risk factors for the development of thrombocytopenia. The lower baseline platelet count was the best predictor of thrombocytopenia, duration of VPA therapy was the second, and infection and aetiologies were the third predictors.</description><identifier>ISSN: 0269-4727</identifier><identifier>EISSN: 1365-2710</identifier><identifier>DOI: 10.1111/jcpt.13125</identifier><identifier>PMID: 32040242</identifier><language>eng</language><publisher>England: Hindawi Limited</publisher><subject>Antiepileptic agents ; Intensive care ; Intravenous administration ; Laboratories ; Mechanical ventilation ; Medical records ; Multivariate analysis ; neurological intensive care unit ; Patients ; Platelets ; Risk factors ; Subarachnoid hemorrhage ; Thrombocytopenia ; Valproic acid</subject><ispartof>Journal of clinical pharmacy and therapeutics, 2020-10, Vol.45 (5), p.1014-1020</ispartof><rights>2020 John Wiley & Sons Ltd</rights><rights>2020 John Wiley & Sons Ltd.</rights><rights>Copyright © 2020 John Wiley & Sons Ltd</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3935-bdba67443d3cb72334bfeee26831bbc76fd8bfc037991ee054048bbba38439743</citedby><cites>FETCH-LOGICAL-c3935-bdba67443d3cb72334bfeee26831bbc76fd8bfc037991ee054048bbba38439743</cites><orcidid>0000-0003-4484-0602</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fjcpt.13125$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fjcpt.13125$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,27903,27904,45553,45554</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32040242$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Kim, Dong Wook</creatorcontrib><creatorcontrib>Kim, Wonshik</creatorcontrib><creatorcontrib>Lee, Chang‐Hoon</creatorcontrib><creatorcontrib>Chun, Young Il</creatorcontrib><title>Thrombocytopenia during intravenous valproic acid therapy in the neurological intensive care unit</title><title>Journal of clinical pharmacy and therapeutics</title><addtitle>J Clin Pharm Ther</addtitle><description>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.
The lower baseline platelet count (<200 × 109/L, OR: 17.25, 95% CI: [7.70‐37.76]), use of VPA for more than 3 days (OR: 3.80, 95% CI: [1.71‐8.43]), aetiologies other than intracranial haemorrhage or subarachnoid haemorrhage (OR: 2.67, 95% CI: [1.40‐5.09]) and infection (OR: 4.20, 95% CI: [1.95‐9.07])were found as independent risk factors for the development of thrombocytopenia. The lower baseline platelet count was the best predictor of thrombocytopenia, duration of VPA therapy was the second, and infection and aetiologies were the third predictors.</description><subject>Antiepileptic agents</subject><subject>Intensive care</subject><subject>Intravenous administration</subject><subject>Laboratories</subject><subject>Mechanical ventilation</subject><subject>Medical records</subject><subject>Multivariate analysis</subject><subject>neurological intensive care unit</subject><subject>Patients</subject><subject>Platelets</subject><subject>Risk factors</subject><subject>Subarachnoid hemorrhage</subject><subject>Thrombocytopenia</subject><subject>Valproic acid</subject><issn>0269-4727</issn><issn>1365-2710</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><recordid>eNp9kE1v1DAQhq2qiG4LF34AitQLQko7_kicHKtVoaBKcFjOlu1MWq-ydmoni_bf43RbDhyYi-fw-NU7DyEfKFzRPNdbO05XlFNWnZAV5XVVMknhlKyA1W0pJJNn5DylLQDUkvG35IwzEMAEWxG9eYxhZ4I9TGFE73TRzdH5h8L5Keo9-jCnYq-HMQZnC21dV0yPGPV4yMSyFh7nGIbw4Kwell_ok9tjYXXEYvZuekfe9HpI-P7lvSC_vtxu1nfl_Y-v39Y396XlLa9K0xldSyF4x63JLbkwPSKyuuHUGCvrvmtMb4HLtqWIUAkQjTFG80bwVgp-QT4dc3PVpxnTpHYuWRwG7TEfoRivOEDTCJbRy3_QbZijz-0UEwJqaEAu1OcjZWNIKWKvxuh2Oh4UBbWIV4t49Sw-wx9fImezw-4v-mo6A_QI_HYDHv4Tpb6vf26OoX8A8oaO7g</recordid><startdate>202010</startdate><enddate>202010</enddate><creator>Kim, Dong Wook</creator><creator>Kim, Wonshik</creator><creator>Lee, Chang‐Hoon</creator><creator>Chun, Young Il</creator><general>Hindawi Limited</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>7TM</scope><scope>7TO</scope><scope>H94</scope><scope>K9.</scope><scope>M7N</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-4484-0602</orcidid></search><sort><creationdate>202010</creationdate><title>Thrombocytopenia during intravenous valproic acid therapy in the neurological intensive care unit</title><author>Kim, Dong Wook ; Kim, Wonshik ; Lee, Chang‐Hoon ; Chun, Young Il</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3935-bdba67443d3cb72334bfeee26831bbc76fd8bfc037991ee054048bbba38439743</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Antiepileptic agents</topic><topic>Intensive care</topic><topic>Intravenous administration</topic><topic>Laboratories</topic><topic>Mechanical ventilation</topic><topic>Medical records</topic><topic>Multivariate analysis</topic><topic>neurological intensive care unit</topic><topic>Patients</topic><topic>Platelets</topic><topic>Risk factors</topic><topic>Subarachnoid hemorrhage</topic><topic>Thrombocytopenia</topic><topic>Valproic acid</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Kim, Dong Wook</creatorcontrib><creatorcontrib>Kim, Wonshik</creatorcontrib><creatorcontrib>Lee, Chang‐Hoon</creatorcontrib><creatorcontrib>Chun, Young Il</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>Nucleic Acids Abstracts</collection><collection>Oncogenes and Growth Factors Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of clinical pharmacy and therapeutics</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Kim, Dong Wook</au><au>Kim, Wonshik</au><au>Lee, Chang‐Hoon</au><au>Chun, Young Il</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Thrombocytopenia during intravenous valproic acid therapy in the neurological intensive care unit</atitle><jtitle>Journal of clinical pharmacy and therapeutics</jtitle><addtitle>J Clin Pharm Ther</addtitle><date>2020-10</date><risdate>2020</risdate><volume>45</volume><issue>5</issue><spage>1014</spage><epage>1020</epage><pages>1014-1020</pages><issn>0269-4727</issn><eissn>1365-2710</eissn><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.
The lower baseline platelet count (<200 × 109/L, OR: 17.25, 95% CI: [7.70‐37.76]), use of VPA for more than 3 days (OR: 3.80, 95% CI: [1.71‐8.43]), aetiologies other than intracranial haemorrhage or subarachnoid haemorrhage (OR: 2.67, 95% CI: [1.40‐5.09]) and infection (OR: 4.20, 95% CI: [1.95‐9.07])were found as independent risk factors for the development of thrombocytopenia. The lower baseline platelet count was the best predictor of thrombocytopenia, duration of VPA therapy was the second, and infection and aetiologies were the third predictors.</abstract><cop>England</cop><pub>Hindawi Limited</pub><pmid>32040242</pmid><doi>10.1111/jcpt.13125</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0003-4484-0602</orcidid><oa>free_for_read</oa></addata></record> |
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| ispartof | Journal of clinical pharmacy and therapeutics, 2020-10, Vol.45 (5), p.1014-1020 |
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| source | Wiley Online Library Journals Frontfile Complete |
| subjects | Antiepileptic agents Intensive care Intravenous administration Laboratories Mechanical ventilation Medical records Multivariate analysis neurological intensive care unit Patients Platelets Risk factors Subarachnoid hemorrhage Thrombocytopenia Valproic acid |
| title | Thrombocytopenia during intravenous valproic acid therapy in the neurological intensive care unit |
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