Abstract
Introduction
Adrenocorticotropic hormone (ACTH) therapy is a first-line treatment for infantile
spasms, which may rarely cause intracranial hemorrhage. However, the changes in blood
coagulation during ACTH therapy are poorly understood, with little description in
the management guidelines.
Objective
To assess the changes in blood coagulation during ACTH therapy.
Patients/Methods
This retrospective study reviewed the medical records of 10 patients diagnosed with
infantile spasms and treated with ACTH therapy, between January 2015 and March 2021.
The underlying diseases included intracranial hemorrhage, hypoxic-ischemic encephalopathy,
tuberous sclerosis, and cerebral infarction. Antiepileptic drugs administered were
valproic acid (VPA), vitamin B6, zonisamide, topiramate, clobazam, clonazepam, and
phenobarbital.
Results
The 10 patients had a median age of 8 months (4–17 months) and included eight males.
The median fibrinogen (Fbg) level before ACTH therapy was 202 mg/dL (125–392 mg/dL);
however, this significantly decreased to 108.5 mg/dL (65–135 mg/dL) during treatment
at a median of 12 days after (days 8–17) (p < 0.01). Decreased Fbg levels were observed
with and without VPA. This suggests the possible influence of ACTH therapy on Fbg
levels, irrespective of the VPA combination. Additionally, prothrombin time and activated
partial thromboplastin time were significantly shortened when compared to those before
ACTH therapy and at the lowest of Fbg levels.
Conclusions
Careful coagulation monitoring, especially during the second week of treatment, is
necessary for the safe completion of ACTH therapy, with or without concomitant VPA.
Keywords
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Article Info
Publication History
Published online: April 29, 2022
Accepted:
April 12,
2022
Received in revised form:
April 8,
2022
Received:
November 22,
2021
Footnotes
☆Presentation: The abstract of this paper was presented at the 63rd Annual Meeting of the Japanese Society of Pediatric Neurology, Fukuoka, Japan, 2021.
Identification
Copyright
© 2022 The Japanese Society of Child Neurology Published by Elsevier B.V. All rights reserved.
