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Blood coagulation dynamics during adrenocorticotropic hormone therapy in pediatric patients with infantile spasms

Yoko Takeda1, Takafumi Sakakibara1, Kenichi Ogiwara1

  • 1Department of Pediatrics, Nara Medical University, Kashihara, Nara, Japan.

Brain & Development
|May 2, 2022
PubMed

Insights

Adrenocorticotropic hormone (ACTH) therapy for infantile spasms can decrease fibrinogen levels, impacting blood coagulation. Monitoring is crucial, especially during the second week of treatment, regardless of valproic acid use.

Area of Science:

  • Pediatric Neurology
  • Hematology
  • Pharmacology

Background:

  • Adrenocorticotropic hormone (ACTH) therapy is a primary treatment for infantile spasms.
  • ACTH therapy can rarely lead to intracranial hemorrhage.
  • Blood coagulation changes during ACTH therapy are not well-documented in clinical guidelines.

Purpose of the Study:

  • To investigate the effects of ACTH therapy on blood coagulation parameters in infants with spasms.

Main Methods:

  • Retrospective analysis of 10 patients treated with ACTH for infantile spasms (2015-2021).
  • Underlying conditions included intracranial hemorrhage, hypoxic-ischemic encephalopathy, tuberous sclerosis, and cerebral infarction.
  • Coagulation parameters (fibrinogen, prothrombin time, activated partial thromboplastin time) were assessed before and during ACTH treatment, with or without valproic acid (VPA).

Main Results:

  • A significant decrease in median fibrinogen levels was observed during ACTH therapy (202 mg/dL to 108.5 mg/dL, p < 0.01).
  • Fibrinogen reduction occurred irrespective of concomitant valproic acid (VPA) administration.
  • Prothrombin time and activated partial thromboplastin time were significantly shortened during ACTH therapy compared to baseline.

Conclusions:

  • ACTH therapy significantly alters blood coagulation, notably reducing fibrinogen levels.
  • Close coagulation monitoring, particularly in the second week of therapy, is recommended for safe treatment.
  • These findings are relevant for managing infantile spasms and potential bleeding risks associated with ACTH treatment.
Abstract

Keywords:
Adrenocorticotropic hormone (ACTH) therapyCoagulation disordersHypofibrinogenemiaInfantile spasmsIntracranial hemorrhage

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