NeoplasmFactor XIII deficiency and postoperative hemorrhage after neurosurgical procedures
Section snippets
Materials and methods
A total of 1264 patients who underwent intracranial surgery at our institution (January 1995–June 1997) were included in this study. All patients were investigated retrospectively for the occurrence of major postoperative hemorrhage, defined as hemorrhage associated with significant clinical/neurological deterioration. Preoperative and postoperative coagulation tests including platelets (PLTS), partial thromboplastin time (PTT), prothrombin time (PT), fibrinogen (F), and antithrombin III (AT
Results
In this series of 1264 patients, a total of 20 patients (1.6%) suffered from a major postoperative hemorrhage. Factor XIII testing was performed postoperatively in 34 patients in whom coagulation abnormalities were suspected (thromboembolic events, postoperative hemorrhage, or wound hematoma). Eleven of these 34 patients (32.3%) had a major postoperative hemorrhage. Factor XIII was normal (more than 60%) in 26 patients, and eight patients were found to have a Factor XIII deficiency. All
Discussion
Of our 1264 patients 542 (42.9%) had surgery for brain tumors. Those patients were found to have complex hemostatic abnormalities 11, 12, 21, 25; however they are mostly associated with a hypercoagulative state 16, 17, 23.
Routine parameters are effective for monitoring the intrinsic (PTT) and extrinsic (PT) coagulation pathways and helping to identify deficits up to the generation of fibrin monomers. In the final step of the clotting cascade the enzymatic cross-linking of fibrin is catalyzed by
Conclusion
In our study, decreased Factor XIII activity was associated with an increased risk of postoperative hemorrhage after intracranial surgery. However, prospective data on preoperative and postoperative Factor XIII activity is required to elucidate the significance of decreased Factor XIII levels and the association with other clinical parameters in patients undergoing neurosurgical procedures. If postoperative hemorrhage occurs, Factor XIII deficiency should be considered.
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2019, World NeurosurgeryCitation Excerpt :The precise definition of intracranial POH after cranial operation is controversial.4 Participants with both clinical deterioration and postoperative radiologic evidence of intracranial bleeding were diagnosed with POH in several previous studies.5-7 In the present study, considering that postoperative intracranial hemorrhage requiring reoperation was much more clinically significant than hematoma, which needed only close observation and pharmacologic treatment, we defined POH as postoperative intracranial hemorrhage (including hematoma located at the operative site and remote intracranial hemorrhage) requiring surgical evacuation, which was consistent with some previous studies.8-11