Haemostatic changes during surgery for primary brain tumours

Goh, Keith Y.C.; Tsoi, W. C.; Feng, Chi-Shun; Wickham, Nicholas; Poon, Wai Sang

doi:10.1136/jnnp.63.3.334

Cited by 68 publications

(48 citation statements)

References 23 publications

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“…It seems to be more sensitive and specific than routine coagulation tests in detecting defects of the coagulation system [16, [18][19][20][21][22].…”

Section: Discussionmentioning

confidence: 99%

Ethanol impairs coagulation and fibrinolysis in whole blood: a study performed with rotational thromboelastometry

Engström

Schött

Reinstrup

2006

Blood Coagulation &Amp; Fibrinolysis

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Objective: The objective of the study was to study the effects of ethanol on the coagulation and the fibrinolysis in whole blood. Methods: Blood samples from healthy volunteers were analysed before and after in vitro addition of ethanol in order to achieve ethanol concentrations of 0‰, 1‰, 2‰ and 4‰ respectively (0, 22, 44 and 88 mmol/l). Coagulation and fibrinolysis were then assessed using rotational thromboelastometry. Results: We found that increasing ethanol levels increasingly impaired coagulation as evaluated with rotational thromboelastometry with a maximum prolongation of Clot Formation Time of 118% at an ethanol level of 4‰ (p<0.000001). We also found a very strong impairment of fibrinolysis already at an ethanol level of 1‰. Conclusions: This is the first study assessing the effects of ethanol on coagulation and fibrinolysis in a whole blood model. The impairment of coagulation is similar in nature to the impairment found in patients suffering from hypothermia. The impairment is at a level that may be of clinical importance, e.g. in patients suffering from trauma. The inhibition of fibrinolysis is obvious already at an ethanol level of 1‰ and it may be a contributing factor to the increased amount of coronary and cerebrovascular ischemic events after binge drinking.

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“…It seems to be more sensitive and specific than routine coagulation tests in detecting defects of the coagulation system [16, [18][19][20][21][22].…”

Section: Discussionmentioning

confidence: 99%

Ethanol impairs coagulation and fibrinolysis in whole blood: a study performed with rotational thromboelastometry

Engström

Schött

Reinstrup

2006

Blood Coagulation &Amp; Fibrinolysis

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“…7,33 Clot resistance to fibrinolysis is enhanced by platelet factor XIIIa-mediated cross-linking of ␣ 2 -antiplasmin to fibrin. 19 At low factor XIII concentrations, only ␥-chain cross-linking of fibrin monomers occurs, while ␣-chain cross-linking is dependent on high factor XIII concentrations.…”

Section: Factor XIII and Fibrinolytic Activitymentioning

confidence: 99%

“…Therefore, the rate is consistent with other reports in which the occurrence of postoperative hematoma was between 1% and 12%. 1,7 The patients underwent major surgical procedures for a variety of different pathologies ( Table 1). As demonstrated in other studies, 1 the incidence of hematoma formation was highest after meningioma surgery (30.8%); this was followed by surgery for brain injury (23.1%).…”

Section: Factor XIII and Fibrinolytic Activitymentioning

confidence: 99%

“…1 Changes in hemostasis during intracranial surgery are miscellaneous and vary from disseminated intravascular coagulation [2][3][4] to deep venous thrombosis. 5,6 These changes were attributed to alterations primarily caused by brain neoplasms 7,8 or to the influence of intracranial surgery itself. 9 Although meticulous surgical hemostasis is of paramount importance to prevent a subsequent hematoma, impaired activation of coagulation and/or increased fibrinolytic activity may nevertheless cause postoperative bleeding.…”

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confidence: 99%

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Increased Risk for Postoperative Hemorrhage After Intracranial Surgery in Patients With Decreased Factor XIII Activity

Gerlach

Tölle

Raabe

et al. 2002

Stroke

179

119

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Background and Purpose-The functional integrity of the hemostatic system is a prerequisite for the safe performance of neurosurgical procedures. To monitor the individual coagulation capacity of each patient, standard tests are effective to detect deficiencies involving the generation of fibrin. However, fibrin clot strength depends primarily on coagulation factor XIII, which cross-links fibrin monomers and enhances clot resistance against fibrinolysis. Therefore, factor XIII is functionally involved in both the hemostatic and fibrinolytic systems. The objective of this prospective study was to determine the incidence and clinical relevance of perioperative decreased factor XIII with respect to standard coagulation parameters and the occurrence of postoperative hematoma. Methods-In 876 patients, 910 neurosurgical procedures were performed. Prothrombin time (PT), partial thromboplastin time (PTT), platelet count, fibrinogen, and factor XIII were tested in each patient preoperatively and postoperatively. Results-Postoperative intracranial hematoma (defined as requiring surgical evacuation) occurred after 39 (4.3%) of 910 surgical procedures. Patients with postoperative hematoma had significantly lower factor XIII and fibrinogen levels preoperatively and postoperatively than patients without hematoma. In patients with postoperative hematoma, PT and platelets differed significantly only postoperatively, whereas PTT was different neither preoperatively nor postoperatively. Of the 39 patients with a postoperative hematoma, 13 (33.3%) had a postoperative factor XIII Ͻ60% compared with 61 (7%) of 867 patients without hematoma (PϽ0.01, Fisher's exact test). The relative risk of developing a postoperative hematoma is therefore increased 6.4-fold in patients with postoperative factor XIII Ͻ60%. The risk is increased 12-fold in patients who additionally have postoperative decreased fibrinogen levels (Ͻ1.5 g/L) and 9-fold in patients with platelet count Ͻ150ϫ10 9 /L and factor XIII Ͻ60%. Conclusions-This is the first prospective study that demonstrates the association of decreased perioperative factor XIII with an increased risk of postoperative hematoma in neurosurgical patients. The risk is further increased in those patients with low factor XIII and additional abnormalities of fibrinogen, PT, platelets, and PTT. Factor XIII testing and specific replacement, as accepted for other clotting factors, may reduce the risk of postoperative hematoma.

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“…Second, initial clinical deterioration in some of these patients could be caused by spontaneous apoplexy in the neoplasm, so incomplete removal of the tumor would not prevent progression of thè`h emorrhagic/ischemic phenomenon.'' 8) Third, immobilization, water and electrolyte abnormalities, and hemoconcentration might cause significant coagulation disorders, 13) which can cause impairment of the clinical condition.…”

Section: Factors Associated With the Outcome After Urgent Reopermentioning

confidence: 99%

Urgent Reoperation for Major Regional Complications After Removal of Intracranial Tumors: Outcome and Prognostic Factors in 100 Consecutive Cases

Chernov¹,

Ivanov²

2007

Neurol. Med. Chir.(Tokyo)

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Outcome of urgent reoperation for major regional complication after removal of intracranial tumor was evaluated retrospectively in 100 consecutive patients treated since 1983. Urgent reoperation was performed from 3 to 240 hours (mean 74 hours) after primary surgery for 32 meningiomas, 23 pituitary adenomas, 22 gliomas, 13 vestibular schwannomas, and 10 other intracranial neoplasms. Mean Glasgow Coma Scale (GCS) score before reoperation was 8. Brain edema was the most frequent operative finding at reoperation (31 patients), followed by extradural hematoma (25) and brain ischemia (24). Removal of various types of intracranial hematomas was the most common surgical procedure at reoperation (47 cases). Final outcome was considered favorable in 54 patients, who were discharged without major neurological deficit, and unfavorable in 46, with severe disability or vegetative state in four and death in 42. Multivariate analysis showed statistically significant association with the outcome for histological type of the tumor (p º 0.0001), clinical state at admission (p º 0.001), GCS score before urgent reoperation (p ＝ 0.001), time interval between primary surgery and urgent reoperation (p º 0.01), and patient age (p º 0.05). Therefore, the outcome after urgent reoperation due to major regional complications after removal of intracranial tumor is determined mainly by the clinical condition of the patient and characteristics of the tumor, and less influenced by the type of complication.

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Haemostatic changes during surgery for primary brain tumours

Cited by 68 publications

References 23 publications

Ethanol impairs coagulation and fibrinolysis in whole blood: a study performed with rotational thromboelastometry

Ethanol impairs coagulation and fibrinolysis in whole blood: a study performed with rotational thromboelastometry

Increased Risk for Postoperative Hemorrhage After Intracranial Surgery in Patients With Decreased Factor XIII Activity

Urgent Reoperation for Major Regional Complications After Removal of Intracranial Tumors: Outcome and Prognostic Factors in 100 Consecutive Cases

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