Analysis of perioperative period coagulation function affected by anti-seizure medications in epilepsy surgery

Drug-resistant epilepsy is a chronic condition that refers to epilepsy that does not improve with adequate medication treatment. For such cases, surgical intervention is a crucial strategy. However, in some patients, hemorrhage may occur after the operation. Proper management of anti-seizure medications is essential for perioperative care in epilepsy surgery. It should be noted that certain anti-seizure medications may negatively affect coagulation function. In this study, we aim to summarize the coagulation function of epilepsy patients during the perioperative period and compare the postoperative coagulation function when using sodium valproate and levetiracetam. Eighty-two epilepsy patients (age = 30.79 ± 10.30 years old; M:F = 49:33) who underwent surgical treatments in Peking Union Medical College Hospital from April 2019 to April 2023 were enrolled in the study. Coagulation functions were evaluated using laboratory examination. Based on their perioperative medication, they were divided into two groups - sodium valproate and levetiracetam. We used t-test to measure the coagulation function parameters affected by the operation and then used independent t-test to determine the differences in coagulation function between the two groups. Abnormal PT, APTT, Fbg within 3 days after operation were found 84.8%, 28.3%, 93.5% respectively in patients using sodium valproate intravenous preparation, while these parameters were 38.9%, 25.0%, 83.3% respectively in patients using levetiracetam intravenous preparation. The patients who took sodium valproate intravenous preparation get higher value of PT increase in perioperative time compared to patients using levetiracetam intravenous preparation. Patients with epilepsy are at risk of experiencing abnormal coagulation function following epilepsy surgery. It has been observed that patients may experience more severe and prolonged prothrombin time (PT) when using intravenous valproic acid preparation during the perioperative period, as compared to using levetiracetam intravenous preparation. These findings highlight the importance of monitoring coagulation function after epilepsy surgery. Surgeons should closely monitor patients who receive sodium valproate treatment during the perioperative period for any potential impact on their coagulation function post-surgery.