The Prevalence and Risk Factors of Coagulopathy in Pediatric Epilepsy Surgery Patients

The Prevalence and Risk Factors of Coagulopathy in Pediatric Patients Undergoing Surgery for Epilepsy

The hematologic consequences of novel Anti-seizure medications (ASMs) are rarely reported.

Whether coagulation dysfunctions increase the risk of peri-operative bleeding remains controversial.

The research is performed to investigated the incidence and risk factors of preoperative coagulation dysfunction in children undergoing surgery for epilepsy and their impact on surgery.

Study Overview

• Status: Completed
• Conditions: Epilepsy; Seizure; Epilepsy in Children; Coagulation and Hemorrhagic Disorders; Antiepileptic Adverse Reaction

Detailed Description

Epilepsy is a common disease of the nervous system with severe consequences. Epidemiological surveys have shown that the prevalence of epilepsy in China is approximately 0.4-0.7%, comprising 7-10 million patients with epilepsy, most of whom are children. Although most symptoms of epilepsy can be controlled with the use of anti-seizure medications (ASMs), there are still a few patients who cannot achieve satisfactory seizure control with such medications or cannot tolerate their side effects, thus requiring surgical treatment. Surgical treatment of epilepsy has been recognized as a valuable treatment option for carefully selected patients to achieve better seizure control and quality of life. Compared to adults, children with epilepsy with indications for surgery usually have a better prognosis after surgical treatment. Many children undergoing surgery for epilepsy have a long history of using ASMs. Moreover, ASM therapy usually consists of multiple varieties of drugs, thereby bringing significant attention to the side effects of ASMs, especially those that may be relevant in the perioperative surgical setting.

ASMs have been associated with multiple adverse effects on platelets and the coagulation system. Valproic acid (VPA), one of the most commonly used traditional ASM, has been reported to cause multiple hematologic abnormalities, including thrombocytopenia, platelet aggregation dysfunction, fibrinogen (FBG) depletion, bone marrow suppression, decreased factor XIII, and acquired von Willebrand disease. However, the wide use of novel ASMs in recent decades has led to decreased reports of adverse events. The hematologic consequences of these novel ASMs or combined therapies are rarely reported. Few studies have suggested that levetiracetam (LEV) does not cause clinically significant or relevant hematological disorders.

Such reported side effects may be more significant in pediatric patients with epilepsy due to individual differences in age, weight, and pharmacokinetic action of the body on the drugs. The incidence of coagulopathies has been reported to be higher in children than in adults, especially hypofibrinogenemia. Nevertheless, whether these coagulation dysfunctions increase the risk of peri-operative bleeding remains controversial. Most investigators suggest that ASMs, including VPA, are not associated with surgery-related blood loss or transfusion requirements. However, a few studies have suggested that considering the extra risk of peri-operative bleeding, VPA should be discontinued before surgery.

This retrospective analysis of 390 children with epilepsy systematically investigated the incidence and risk factors of preoperative coagulation dysfunction in children undergoing surgery for epilepsy and their impact on surgery, with the objective to provide detailed and valuable clinical information.

• Study Type: Observational
• Enrollment (Actual): 494

Contacts and Locations

Study Locations

• China
  • Shanghai
    • Shanghai, Shanghai, China, 201102
      • Children's Hospital of Fudan University

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 1 month to 18 years (Child, Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

• Sampling Method: Non-Probability Sample

Study Population

The study population were children who were hospitalized between January 2015 and December 2021 at the Neurosurgery Department of Children's Hospital of Fudan University, including non-epileptic children who underwent non-epilepsy neurological surgery by the same surgeon and were admitted at the same period for control.

• 319 patients with epilepsy who administered Anti-seizure Medications (ASMs);
• 71 patients with epilepsy who were not administered ASMs;
• 104 non-epileptic children who underwent neurosurgical operations and had never taken any ASMs.

Description

Inclusion Criteria:

• Age<18 years
• A discharge diagnosis of "epilepsy" according to the International Classification of Diseases (ICD-10)
• Received surgical treatment for epilepsy during the hospitalization
• Hospitalized between January 2015 and December 2021 at the Neurosurgery Department of Children's Hospital of Fudan University
• Non-epileptic children who underwent non-epilepsy neurological surgery by the same surgeon and were admitted at the same period for control

Exclusion Criteria:

• The clinical information or laboratory examinations were incomplete
• Had concomitant diseases affecting coagulation or liver function
• Patients or parents refused to be enrolled

Study Plan

How is the study designed?

Design Details

• Observational Models: Cohort
• Time Perspectives: Retrospective

Number of groups / cohorts

3

Cohorts and Interventions

Group / Cohort
EP with ASMs; Epilepsy patients who administered Anti-seizure Medications(ASMs)
EP without ASMs; Epilepsy patients who were not administered ASMs
No EP; Non-epileptic children and had never taken any ASMs

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Factors related to coagulation function	The following clinical data were collected: sex, age, weight, epilepsy course, and anti-seizure therapy. The initial laboratory data after admission included platelet count (PLT), prothrombin time (PT), activated partial thromboplastin time (APTT), FBG, alanine aminotransferase (ALT), and aspartate aminotransferase (AST). We also collected data on non-epileptic children who underwent non-epilepsy neurological surgery and were admitted at the same period from the Hospital Information System (HIS) as a control cohort. Multivariate logistic regression analysis was performed to identify independent determinants of coagulation dysfunction. Possible relevant variables were filtered out using univariate logistic regression and further included as covariates for the multivariate logistic regression.	From hospitalization to surgery, an average of 3 days

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Proportion of coagulation dysfunction between groups	Proportion of cases with or without coagulation dysfunction in epileptic children with ASMs, epileptic children without ASMs, and non-epileptic children.	From hospitalization to surgery, an average of 3 days
Variables affecting coagulation function	Univariate analysis and logistic regression identified the risk factors for coagulopathy in paediatric patients undergoing epilepsy surgery.	From hospitalization to surgery, an average of 3 days
Affected laboratory index	Laboratory index affected by the independent determinants of coagulation dysfunction (PT, APTT, FBG or PLT).	From hospitalization to surgery, an average of 3 days
Incidence of transfusion	Whether the independent determinants of coagulation dysfunction increase the incidence of surgical-related transfusion.	From surgery to discharge, an average of 7 days

Collaborators and Investigators

• Sponsor: Children's Hospital of Fudan University

Study record dates

Study Major Dates

• Study Start (Actual): December 1, 2022
• Primary Completion (Actual): December 24, 2022
• Study Completion (Actual): December 24, 2022

Study Registration Dates

• First Submitted: December 29, 2022
• First Submitted That Met QC Criteria: December 29, 2022
• First Posted (Estimate): January 9, 2023

Study Record Updates

• Last Update Posted (Estimate): January 9, 2023
• Last Update Submitted That Met QC Criteria: December 29, 2022
• Last Verified: December 1, 2022

More Information

Terms related to this study

• Keywords: Epilepsy; Surgery; Pediatric; Coagulation Function; Anti-seizure Medications
• Additional Relevant MeSH Terms: Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Neurologic Manifestations; Hematologic Diseases; Epilepsy; Seizures; Hemorrhagic Disorders
• Other Study ID Numbers: No. 2022-355

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: No
• IPD Plan Description: According to the Ethic Board of Children's Hospital of Fudan University, the clinical data of patients could not been shared without permission.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No