Elsevier

Surgical Neurology

Volume 54, Issue 3, September 2000, Pages 260-266
Surgical Neurology

Neoplasm
Factor XIII deficiency and postoperative hemorrhage after neurosurgical procedures

https://doi.org/10.1016/S0090-3019(00)00308-6Get rights and content

Abstract

BACKGROUND

Factor XIII is of physiological importance for hemostasis, especially in patients undergoing surgery. It catalyzes the enzymatic cross-linking of fibrin monomers into stable polymers and protects polymers from plasmatic and nonspecific degradation. Postoperative hemorrhage in patients with congenital and acquired Factor XIII deficiencies has been described in various surgical fields. However, there are no data about the incidence and clinical relevance of decreased Factor XIII after neurosurgical procedures. The objective of our study was to investigate the association between Factor XIII deficiency and postoperative hemorrhage after intracranial surgery.

METHODS

A total of 1264 patients who underwent intracranial operations were reviewed retrospectively. Standard coagulation parameters were monitored during the perioperative course in all patients. Factor XIII testing was performed postoperatively in 34 patients in whom coagulopathies were suspected despite normal platelets, fibrinogen, prothrombin, and partial thromboplastin time. Data were analyzed to evaluate the association of Factor XIII deficiency and major postoperative hemorrhage.

RESULTS

In this series of 1264 patients, a total of 20 patients (1.6%) suffered from a major postoperative hemorrhage. Of the 34 patients with suspected coagulopathies and postoperative Factor XIII testing, 11 had a major postoperative hemorrhage. Normal levels of Factor XIII, defined as more than 60%, were found in 26 of the 34 patients. Factor XIII deficiency, defined as less than 60%, was found in eight patients. All patients with Factor XIII deficiency (n = 8) had a major postoperative hemorrhage. Of the remaining 26 patients with normal Factor XIII levels only three had a postoperative hemorrhage (p < 0.00001, Fisher’s exact test).

CONCLUSIONS

Decreased Factor XIII activity may be associated with an increased risk of postoperative hemorrhage after intracranial surgery.

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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