warfarin and Status-Epilepticus

Valproic acid (VPA) and warfarin are commonly prescribed for patients with epilepsy and concomitant atrial fibrillation (AF). When VPA and warfarin are prescribed together, clinically important interactions may occur. VPA may replace warfarin from the protein binding sites and result in an abnormally increased anticoagulation effect. This is commonly underrecognized.. In our case, we report a 78-year-old woman with a glioma who presented with status epilepticus. The patient was on warfarin to prevent cardiogenic embolism secondary to AF. Intravenous loading dose of VPA was administered, but international normalized ratio (INR) increased significantly to 8.26. Intravenous vitamin K1 was then given and the patient developed no overt bleeding during the hospitalization.. By reviewing the literature and discussing the critical interaction between valproate sodium and warfarin, we conclude that intravenous VPA and the co-administrated warfarin may develop critical but underrecognized complications due to effects on the function of hepatic enzymes and displacement of protein binding sites.

Topics: Aged; Anticoagulants; Anticonvulsants; Atrial Fibrillation; Drug Interactions; Female; Humans; International Normalized Ratio; Protein Binding; Status Epilepticus; Valproic Acid; Warfarin

Stimulus-induced rhythmic, periodic or ictal discharges (SIRPIDs) are EEG epileptiform periodic discharges (PD) induced by arousal. SIRPIDs lie along an ictal-interictal continuum with debate regarding urgency of treatment. In a patient with SIRPIDs, aphasia and confusion, i.v. lorazepam during EEG resulted in improved level of consciousness, return of verbal interaction and regression of SIRPIDs. This suggests that some forms of SIRPIDs may be associated with an ictal confusional state.

Topics: Aged; Anticoagulants; Anticonvulsants; Confusion; Consciousness Disorders; Diabetes Complications; Electroencephalography; Female; Humans; Lorazepam; Seizures; Status Epilepticus; Warfarin