Artikel
The value of extended preoperative coagulation analysis in the prevention of postsurgical bleeding complications in patients undergoing intracranial surgery
Die Bedeutung einer erweiterten Gerinnungsanalyse in der Vermeidung postoperativer Blutungskomplikationen bei Patienten mit intrakraniellen Eingriffen
Suche in Medline nach
Autoren
-
Thomas Kinfe
- Neurochirurgische Klinik, Universitätsklinikum Mannheim, Universität Heidelberg, Mannheim
-
M. Farhadi
- Neurochirurgische Klinik, Universitätsklinikum Mannheim, Universität Heidelberg, Mannheim
-
C. E. Dempfle
- Klinik für Innere Medizin I, Universitätsklinikum Mannheim, Universität Heidelberg, Mannheim
-
P. Schmiedek
- Neurochirurgische Klinik, Universitätsklinikum Mannheim, Universität Heidelberg, Mannheim
-
P. Vajkoczy
- Neurochirurgische Klinik, Universitätsklinikum Mannheim, Universität Heidelberg, Mannheim
| Veröffentlicht: | 23. April 2004 |
|---|
Gliederung
Text
Objective
Postsurgical bleeding is a rare but significant complication after intracranial surgery. A detailed analysis and correction of hemostatic abnormalities might prevent postsurgical bleeding. Therefore, the aim of the study was to evaluate the influence of an extended preoperative coagulation analysis and specific therapy on the incidence of postsurgical bleeding complications in patients undergoing intracranial surgery.
Methods
Between 1/2003 and 12/2003 we retrospectively investigated 238 patients (115 male, 123 female; mean age 55,63±12,17 yrs) undergoing intracranial surgery. In 142 patients partial thrombin time (PT), activated partial thromboplastin time (aPTT), fibrinogen, factors VIII, X, XIII, v.Willebrand factor (vWF) antigen, Ristocetin cofactor, platelet function analysis (PFA 100) and platelet count were performed. In 96 patients only PT, aPTT, and platelet count were measured. In the case of patholgical values coagulation factors were substituted. Bleeding complications, defined as space occupying lesions requiring surgical intervention, were documented. The costs for labaratory coagulation tests and subsequent therapeutic interventions to correct these abnormalities were assessed and a cost/benefit analysis was performed.
Results
Extended preoperative coagulation analysis identified hemostatic abnormalities in 34 patients (24%), of which 25 patients (74%) displayed platelet function disorders. There was no correlation between hemostatic abnormalities and intracranial pathology. Among patients receiving extended coagulation analysis, the rate of bleeding complications was 1% (1/142 patients). Interestingly, this patient was identified to harbor a pathological coagulation disorder, but rebled despite adequate substitution. Among patients without extended coagulation analysis the rate of bleeding was 1,5%. In total, the costs for the extended coagulation analysis and substitution therapy were 60 000 Euro, while the costs for routine laboratory tests amounted to 1440 Euro.
Conclusions
Extended preoperative coagulation analysis demonstrated an unexpectedly large proportion of coagulation disorders in this neurosurgical patient population. Nevertheless, based on our cost/benefit analysis we suggest that an extended preoperative coagulation screening should not be performed routinely, but should be limited to patients with a history of bleeding disorders.
