The effects of antiepileptic drugs on warfarin anticoagulation_Journal of Epilepsy

Authors：

 XUE Hong , WENG Ning , WANG Qiang

Department of Neurology, the Second Clinical Medical College Of Guiyang University of Chinese Medicine, Guiyang 550001, China;

Corresponding author：

XUE Hong, Email: 1789366146@qq.com

Keywords：

Antiepileptic drug; Warfarin; Anticoagulation; Adverse reactions

DOI：

10.7507/2096-0247.20190005

Video：

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Objective To investigate the effects of antiepileptic drugs (AEDs) with warfarin functions and blood coagulation system, to provide the reference for clinicians of the selection of AEDs under the combination therapy with warfarin. Methods Analyse the clinical data of the patient with symptomatic epilepsy from the Second Clinical Medical College of Guiyang University of Chinese Medicine on April 1, 2017, whom taking AEDs and warfarin at the same time, clear the drug adverse reactions, and analysed related literature. Results After the treatment with valproate, abnormal blood coagulation, a danger and emergency data appeared, so we stopped using warfarin immediately, and reduce the dosage of valproate gradually, insteadly, we used levetiracetam as antiepileptic therapy. Monitoring blood coagulation function, when it returned to normal, restart warfarin anticoagulant therapy. Conclusions When start antiepileptic treatment in relevant basic diseases of symptomatic epilepsy, for a variety of combination reactions, AEDs can affect the anticoagulant effect of warfarin, so we need to consider the interaction between drugs and avoid adverse reactions.

Citation： XUE Hong, WENG Ning, WANG Qiang. The effects of antiepileptic drugs on warfarin anticoagulation. Journal of Epilepsy, 2019, 5(1): 26-29. doi: 10.7507/2096-0247.20190005 Copy

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3.	David C, Richard W, Susan M, et a1. Stroke prevention in atrial fibrillation study: finalresults. Circulation, 1991, 84(2): 527-539.
4.	Gage BF, Waterman AD, Shannon W, et al. Validation of clinical classification schemes for predicting stroke: results from the National Registry of Atrial Fibrillation. JAMA, 2001, 285(22): 2864-2870.
5.	Yoon HW, Giraldo EA, Wijdicks EF. Valproic acid and warfarin: an underrecognized drug interaction. Neurocritical Care, 2011, 15(1): 182-185.
6.	Acharya S, Bussel JB. Hematologic toxicity of sodium valproate. J Pediatr Hematol Oncol, 2000, 22(3): 62-65.
7.	Mannheimer B, Andersson ML, Jarnbert-Pettersson H, et al. The effect of carbamazepine on warfarin anticoagulation: a register-based nationwide cohort study involving the Swedish population. Thrombosis and Haemostasis, 2016, 14(5): 765-771.
8.	Clark NP, Hoang K, Delate T, et al. Warfarin interaction with hepatic cytochrome P-450 enzyme-inducing anticonvulsants. Clin Appl Thromb Hemost, 2018, 24(1): 172-178.
9.	Krämer G, Tettenborn B, Klosterskov Jensen P, et al. Oxcarbazepine does not affect the anticoagulant activity of warfarin. Epilepsia, 1992, 33(6): 1145-1148.
10.	Ahmed SN. Antiepileptic drugs and warfarin. Canadian Medical Association Journal, 2008, 178(1): 65, author reply 65.
11.	Hassan Y, Awaisu A, Aziz NA, et al. The complexity of achieving anticoagulation control in the face of warfarin-phenytoin interaction: an asian case report. Pharm World Science, 2005, 27(1): 16-19.
12.	Chtydodyomos P Panayiotopoulos. 吴立文主审, 任连坤主译. 癫痫发作和综合征的诊断与治疗. 中国协和医科大学出版社, 2008: 467.
13.	Hamer HM. Seizures nd epilepsies after stroke. Nervenarzt, 2009, 80(4): 405-414.
14.	Sayal KS, Duncan-McConnell DA, McConnell HW, et al. Psychotropic interaction with warfarin. Acta Psychiatr Scand, 2000, 102(4): 250-255.
15.	Patsalos PN. Clinical pharmacokinetics of levetiracetam. Clinical Pharmacokinet, 2004, 43(11): 707-724.

1. 孙艺红, 胡大一. 华法林仍然是人工心脏瓣膜置换术后长期抗凝的唯一选择. 中华心血管病杂志, 2013, 4(4): 266.
2. The Boston anticoagnintion trial for atrial fibrillation investigators. The effect of low—dose warfarin on the risk of stroke in patients with nonrheumaticatrial fibrilation. N Engl J Med, 1990, 323(22): 1505-1511.
3. David C, Richard W, Susan M, et a1. Stroke prevention in atrial fibrillation study: finalresults. Circulation, 1991, 84(2): 527-539.
4. Gage BF, Waterman AD, Shannon W, et al. Validation of clinical classification schemes for predicting stroke: results from the National Registry of Atrial Fibrillation. JAMA, 2001, 285(22): 2864-2870.
5. Yoon HW, Giraldo EA, Wijdicks EF. Valproic acid and warfarin: an underrecognized drug interaction. Neurocritical Care, 2011, 15(1): 182-185.
6. Acharya S, Bussel JB. Hematologic toxicity of sodium valproate. J Pediatr Hematol Oncol, 2000, 22(3): 62-65.
7. Mannheimer B, Andersson ML, Jarnbert-Pettersson H, et al. The effect of carbamazepine on warfarin anticoagulation: a register-based nationwide cohort study involving the Swedish population. Thrombosis and Haemostasis, 2016, 14(5): 765-771.
8. Clark NP, Hoang K, Delate T, et al. Warfarin interaction with hepatic cytochrome P-450 enzyme-inducing anticonvulsants. Clin Appl Thromb Hemost, 2018, 24(1): 172-178.
9. Krämer G, Tettenborn B, Klosterskov Jensen P, et al. Oxcarbazepine does not affect the anticoagulant activity of warfarin. Epilepsia, 1992, 33(6): 1145-1148.
10. Ahmed SN. Antiepileptic drugs and warfarin. Canadian Medical Association Journal, 2008, 178(1): 65, author reply 65.
11. Hassan Y, Awaisu A, Aziz NA, et al. The complexity of achieving anticoagulation control in the face of warfarin-phenytoin interaction: an asian case report. Pharm World Science, 2005, 27(1): 16-19.
12. Chtydodyomos P Panayiotopoulos. 吴立文主审, 任连坤主译. 癫痫发作和综合征的诊断与治疗. 中国协和医科大学出版社, 2008: 467.
13. Hamer HM. Seizures nd epilepsies after stroke. Nervenarzt, 2009, 80(4): 405-414.
14. Sayal KS, Duncan-McConnell DA, McConnell HW, et al. Psychotropic interaction with warfarin. Acta Psychiatr Scand, 2000, 102(4): 250-255.
15. Patsalos PN. Clinical pharmacokinetics of levetiracetam. Clinical Pharmacokinet, 2004, 43(11): 707-724.

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