Artikel
Thromboembolic disorders in neurosurgical patients with brain tumours – Prognostic value of different clotting parameters
Thrombembolische Komplikation bei neurochirurgischen Patienten mit Hirntumoren – Prognostische Wertigkeit verschiedener Gerinnungsparameter
Suche in Medline nach
Autoren
-
D. Freudenstein
- Klinik für Neurochirurgie, Eberhard Karls Universität, Tübingen
-
K. Lutz
- Klinik für Neurochirurgie, Eberhard Karls Universität, Tübingen
-
R. Ritz
- Klinik für Neurochirurgie, Eberhard Karls Universität, Tübingen
-
F. Roser
- Klinik für Neurochirurgie, Eberhard Karls Universität, Tübingen
-
F. Duffner
- Klinik für Neurochirurgie, Eberhard Karls Universität, Tübingen
-
M. Tatagiba
- Klinik für Neurochirurgie, Eberhard Karls Universität, Tübingen
| Veröffentlicht: | 8. Mai 2006 |
|---|
Gliederung
Text
Objective: Thromboembolism in patients with brain tumours is a too common problem in day to day neurosurgical practice. This study focusses on the prognostic value of different parameters to identify patients at risk for thrombembolic disorders in the perioperative course.
Methods: One hundred consecutive patients with various brain tumours (27 meningiomas, 29 gliomas, 15 pituritary adenomas, 12 metastases, 17 others) admitted for craniotomy were included.The following parameters were evaluated: bleeding time (in vivo/vitro), prothrombin time (Quick), partial thromboplastin time (PTT), antithrombin III (AT III), fibrinogen, plasmin inhibitior (PI), D-dimer, haemoglobin, haematocrit, platelets, Factor VIII and IX, von Willebrand’s Factor (vWF), ristocetin co-factor (RcF), C-reactive protein, medication, complications, duration of craniotomy, clinical examination and past medical history focused on thromboembolic events/riskfactors. Blood samples were taken 24 hours before/after craniotomy and on the third and seventh postoperative day.
Results: Most sensitive preoperative clotting parameters for thromboembolic complications (average on 7th postoperative day) were AT III, PI, Factor VIII and IX, vWF and RcF. A prolonged operation time >4 hoursshowed a positive correlation with a higher risk for thromboembolic complications (incidence rate: pulmonary embolism 1% and deep vein thrombosis 4%), especially in cases of meningioma (7.4%) compared with glioma (3.5%) and others (2.3%). The most sensitive clotting parameter was a decrease in AT III activity. Preoperatively all patients with thrombomembolic complications showed a prolonged bleeding time (in vivo and in vitro).
Conclusions: Based on study data and a cost-benefit analysis of the different parameters, a preoperative screening flowchart was elaborated. In case of an inconspicuous past medical history regarding haemostatic disorders and risk factors, preoperative screening can be restricted to the investigation of Quick, PTT, platelet count and bleeding time (in vivo/vitro). Pathological findings require additional examinations (AT III, D-dimer, fibrinogen, PI, F VIII, F IX and vWF).
