Moderate
Probable
Deskripsi
Valproic acid can displace warfarin from plasma protein binding sites and may inhibit platelet aggregation, increasing bleeding risk.
Mekanisme
Valproic acid displaces warfarin from albumin binding, transiently raising free warfarin concentrations; it also inhibits platelet aggregation independently through uncertain mechanisms.
Signifikansi Klinis
Total warfarin levels may appear unchanged while free fraction rises; bleeding risk is increased even without marked INR changes.
Penatalaksanaan
Monitor INR and clinical signs of bleeding closely when combining; measure free warfarin levels if available. Adjust dose if INR changes.