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Effect of Antiepileptic Therapy on Platelet Aggregation

Background: It has already been shown that some antiepileptic drugs, especially valproic acid (VA) and its derivatives, alter platelet function. However, little is known about effect of dual antiepileptic therapy and/or combination of antiepileptic drugs with antiplatelet therapy such as acetylsalicylic acid (ASA). Aims: To investigate an effect of mono and dual antiepileptic therapy and in combination with ASA applied as an antiplatelet drug. Methods: The study included 102 patients using antiepileptic therapy. Testing was done on Sysmex CS2500 analyzer (method: light transmission aggregometry (LTA)) using ADP (2 µmol/L), epinephrine (5 µmol/L) and collagen (2 µg/mL) as agonists (all HYPHEN BioMed, France). Platelet rich plasma and platelet poor plasma were obtained from 3.2% citrate plasma centrifuged at 500 xg/10 minutes and 2000 xg/10 minutes, respectively. The differences between subgroups were tested using Kruskal-Wallis test. Results: LTA results were: ADP 50% (44-74) ; epinephrine 54% (41-78) and collagen 71% (43- 79). One third (31.3%) of patients were using combination of drugs (other antiepileptic or ASA) and 65 (63.7%) were taking VA. There was no difference between ADP (P=0.144), epinephrine (P=0.246) and collagen (P=0.431) results depending on antiepileptic used in all patients. Results differed between patients using monotherapy vs dual antiepileptic therapy for epinephrine 65% (44-79) vs 44% (37-51) ; P=0.001] and collagen [73% (47-79)] vs 43% (29- 70) ; P=0.005] (Table 1). Difference is obtained in patients using only VA vs VA combined with ASA for epinephrine [73% (44-80) vs 42% (23-74) ; P=0.020] and in patients using only VA vs dual antiepileptic therapy [65% (41-78) vs 84% (53-85) ; P=0.020] (Table 2). Conclusions: Dual antiepileptic drug therapy inhibit platelet aggregation induced by epinephrine and collagen. Platelet aggregation is inhibited if induced by epinephrine in patients treated with valproic acid as monotherapy and if it is combined with ASA.

antiepileptics, platelet aggregation

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