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Case Reports
. 2025 Mar 3;9(2):102721.
doi: 10.1016/j.rpth.2025.102721. eCollection 2025 Feb.

A rare case of factor X deficiency induced by valproic acid

Pierre-Antonin Rigon  1 , Vincent Ernest  2
Affiliations
Case Reports

A rare case of factor X deficiency induced by valproic acid

Pierre-Antonin Rigon et al. Res Pract Thromb Haemost. .

Abstract

Background: Factor X (FX) deficiency (FXD) significantly disrupts coagulation, potentially leading to severe bleeding. While inherited FXD is rare, with a prevalence of 1 in 500,000, acquired FXD is also uncommon and frequently linked to conditions such as light-chain amyloidosis. In rare cases, certain medications can cause FXD.

Key clinical question: Here, we present a rare case of acquired FXD induced by valproic acid (VPA). This deficiency is associated with the presence of anti-FX antibodies.

Clinical approach: A 65-year-old man undergoing treatment for various conditions, including chronic kidney disease and type 2 diabetes, developed severe FXD (activity <2 U/L) following VPA administration for epilepsy. During FXD, the patient experienced significant bleeding episodes, necessitating FX replacement with prothrombin complex concentrate. Upon discontinuation of VPA, FX activity improved in 9 days, possibly suggesting a role of the drug in FXD. Interestingly, antibodies directed against FX have been identified.

Conclusion: This case emphasizes the necessity for clinicians to be vigilant of hemostasis disorders associated with VPA, even though such occurrences are rare.

Keywords: blood coagulation; blood coagulation disorders; drug-related side effects and adverse reactions; factor X; factor X deficiency; valproic acid.

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Figures

Figure 1
Figure 1
(A) Evolution of factor X (FX) activity over time following prothrombin complex concentrate infusion. (B) Evolution of hemoglobin levels during the FX deficiency episode, alongside the timeline of red blood cell transfusions. Solid arrows indicate prothrombin complex concentrate infusions; the injected dose is shown above the arrow. Dotted arrows represent the transfusion of 2 units of red blood cell concentrate. IU, International Units.
Figure 2
Figure 2
Thrombin generation assays using Pool Norm (Stago) and plasma from the patient and mixing tests using the patient’s plasma or Owren’s buffer in addition to Pool Norm (Platelet-Poor Plasma Reagent low, tissue factor 1 pM, Stago). Curves represent peak heights at different times during mixing tests using 1:2 patient plasma or 1:2 buffer and 1:2 Pool Norm.
See this image and copyright information in PMC

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