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

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: Adrenocorticotropic hormone (ACTH) therapy; Coagulation disorders; Hypofibrinogenemia; Infantile spasms; Intracranial hemorrhage.