Valproate – Perioperative Bleeding Risk — SCE Neurology MCQ

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ModerateEpilepsy & Seizure DisordersValproate – Perioperative Bleeding RiskSCE Neurology

A 30-year-old woman with epilepsy on sodium valproate is admitted for emergency abdominal surgery. The anaesthetic team needs to know about relevant perioperative risks of valproate. Which haematological complication of valproate is most relevant to the surgical team?

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Correct answer: C — Thrombocytopenia and impaired platelet function

Explanation lettering: E = shown as A · A = shown as B · B = shown as C · C = shown as D · D = shown as E

Sodium valproate can cause dose-dependent thrombocytopenia and impaired platelet aggregation, which may increase intraoperative and postoperative bleeding risk. Pre-operative FBC and coagulation studies should be checked. If platelet count is significantly low or bleeding time prolonged, the surgical team should be informed and platelet transfusion or dose adjustment may be necessary. Valproate also affects von Willebrand factor in some patients. A: Neutropenia is less common. C/D/E: Not typical valproate effects.

Reference: BNF – Sodium Valproate; NICE NG217 (2025)