Daijiworld Media Network - New Delhi

New Delhi, Sep 5: The choice of antiseizure medication may influence the risk of blood clots, bleeding and death among adults with epilepsy taking direct oral anticoagulants (DOACs), according to a large retrospective cohort study.

Researchers evaluated the comparative safety of commonly prescribed antiseizure medications in adults receiving DOAC treatment, using data from an international electronic health record network. The team emulated a target trial and compared levetiracetam, valproate, moderate enzyme-inducing antiseizure medications and strong enzyme-inducing antiseizure medications with a reference group receiving lamotrigine or lacosamide.

Of 2.29 million adults with epilepsy identified in the database, 40,932 were eligible for DOAC treatment. The final analysis included 9,529 people who initiated treatment. Their mean age was 63 years, and 51 per cent were women.

In matched analyses, levetiracetam was associated with a higher risk of thromboembolic events compared with lamotrigine or lacosamide. It was also associated with increased all-cause mortality, while the risk of major bleeding was comparable between the groups.

Strong enzyme-inducing antiseizure medications, including carbamazepine and phenytoin, were similarly associated with an increased risk of thromboembolic events. However, these medications were linked to a lower risk of major bleeding.

Researchers estimated that about 28 per cent of thromboembolic events could potentially have been prevented if outcomes had been similar to those observed in the lamotrigine or lacosamide reference group.

Valproate showed a different risk profile. Compared with the reference group, it was associated with higher all-cause mortality and an increased risk of intracranial major bleeding.

Among adults receiving vitamin K antagonists, meanwhile, thromboembolic risks were reported to be close to null.

The researchers concluded that the choice of antiseizure medication is a potentially modifiable factor affecting outcomes in adults with epilepsy receiving DOACs. They said treatment selection may be important when balancing the risks of thromboembolism and bleeding.