Valproic acid and the risk of perioperative bleeding. Case report and literature review

Abstract

Valproic acid is one of the most widely used drugs for the treatment of epilepsy in children and adults since early in 1967 to the present, and it is also useful for the treatment of refractory epilepsy and multiple conditions. However, the use of this drug has been associated with blood disorders, including bone marrow suppression, alteration of the coagulation cascade and reduction of factor VIII and Von Willebrand factor, in addition to changes in the platelet numbers and function. In terms of the major surgery patient, all of these issues result in an increased risk of perioperative bleeding and a higher requirement of perioperative blood transfusion. A topic for discussion should then be whether the presence of these disorders is relevant for the morbidity and mortality of the patients and whether there is any clinical evidence of benefits for the patient when the drug is interrupted prior to surgery. Many hospital centers recommend stopping the use of valproic acid one to two weeks prior to surgery, though this recommendation is based on controversial evidence. It is our intent to submit a report of an abnormal uterine hemorrhage in the immediate postoperative period of curettage due to incomplete abortion with a history of chronic intake of valproic acid.