E-ISSN: 1019-5157
ISSN: 2651-5024
Research
Safety of Valproic Acid in Intracranial Hemorrhage: Association with Thrombocytopenia, Rebleeding, and Neurosurgical and Functional Outcomes
Barbara Buccilli✉
Neurosurgery - Neurocritical Care, Mount Sinai Hospital
DOI: 10.5137/1019-5149.JTN.50044-25.1
Article in Press
Corresponding Author:
Barbara Buccilli (doctor.b.buccilli@gmail.com)
Abstract
Aim
Valproic acid is sometimes used for seizure prophylaxis in patients with intracranial hemorrhage (ICH), but its safety in this setting, particularly regarding bleeding risk and thrombocytopenia, remains controversial.
Our objective is to evaluate the associations between valproic acid use, thrombocytopenia, and clinical outcomes in patients with intracranial hemorrhage, including nontraumatic ICH, traumatic ICH, subarachnoid hemorrhage (SAH), and intracerebral hemorrhage.
Material and Methods
We conducted a retrospective cohort study using matched analyses to compare patients with intracranial hemorrhage who received valproic acid versus those who did not, and valproic acid users with versus without thrombocytopenia. Demographics, comorbidities, and outcomes including neurosurgical interventions, hemorrhage progression, functional deficits, and mortality were analyzed.
Results
Valproic acid use was associated with higher rates of thrombocytopenia across all hemorrhage subtypes (e.g., 40.0% vs. 26.7% in ICH; OR 1.83, 95% CI 1.302.59; p=0.001). Valproic acid users also experienced increased rates of cognitive deficits, altered mental status, stupor/coma, motor deficits, and need for emergency procedures, although mortality was similar between groups. Among valproic acid users, thrombocytopenia was associated with worse functional outcomes, higher rates of neurosurgical interventions, emergency procedures, and in traumatic ICH, significantly increased mortality (33.3% vs. 8.2%; OR 5.53, 95% CI 2.0914.67; p<0.001).
Conclusion
In patients with intracranial hemorrhage, valproic acid use is linked to higher seizure control but at the cost of increased thrombocytopenia and adverse clinical outcomes, particularly in those who develop thrombocytopenia. These findings suggest caution in the use of valproic acid in this population and highlight the need for careful monitoring and alternative antiseizure strategies.
Valproic acid is sometimes used for seizure prophylaxis in patients with intracranial hemorrhage (ICH), but its safety in this setting, particularly regarding bleeding risk and thrombocytopenia, remains controversial.
Our objective is to evaluate the associations between valproic acid use, thrombocytopenia, and clinical outcomes in patients with intracranial hemorrhage, including nontraumatic ICH, traumatic ICH, subarachnoid hemorrhage (SAH), and intracerebral hemorrhage.
Material and Methods
We conducted a retrospective cohort study using matched analyses to compare patients with intracranial hemorrhage who received valproic acid versus those who did not, and valproic acid users with versus without thrombocytopenia. Demographics, comorbidities, and outcomes including neurosurgical interventions, hemorrhage progression, functional deficits, and mortality were analyzed.
Results
Valproic acid use was associated with higher rates of thrombocytopenia across all hemorrhage subtypes (e.g., 40.0% vs. 26.7% in ICH; OR 1.83, 95% CI 1.302.59; p=0.001). Valproic acid users also experienced increased rates of cognitive deficits, altered mental status, stupor/coma, motor deficits, and need for emergency procedures, although mortality was similar between groups. Among valproic acid users, thrombocytopenia was associated with worse functional outcomes, higher rates of neurosurgical interventions, emergency procedures, and in traumatic ICH, significantly increased mortality (33.3% vs. 8.2%; OR 5.53, 95% CI 2.0914.67; p<0.001).
Conclusion
In patients with intracranial hemorrhage, valproic acid use is linked to higher seizure control but at the cost of increased thrombocytopenia and adverse clinical outcomes, particularly in those who develop thrombocytopenia. These findings suggest caution in the use of valproic acid in this population and highlight the need for careful monitoring and alternative antiseizure strategies.
Keywords
Depakote
Valproate
Intracranial hemorrage
SAH
Thrombocytopenia