Artikel
Clinical impact of preoperative factor XIII activity in chronical and subacute subdural haematoma – a retrospective study
Klinischer Einfluss der präoperativen Faktor XIII Aktivität beim chronischen und subakuten Subduralhämatom – eine retrospektive Studie
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Autoren
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Pawel Gutowski
- Unfallkrankenhaus Berlin, Klinik für Neurochirurgie, Berlin, Deutschland
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Sergej Rot
- Unfallkrankenhaus Berlin, Klinik für Neurochirurgie, Berlin, Deutschland
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Ullrich Meier
- Unfallkrankenhaus Berlin, Klinik für Neurochirurgie, Berlin, Deutschland
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Johannes Lemcke
- Unfallkrankenhaus Berlin, Klinik für Neurochirurgie, Berlin, Deutschland
| Veröffentlicht: | 26. Juni 2020 |
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Gliederung
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Objective: We analyzed the preoperative activity of factor XIII in patients with subdural hematoma (SDH) in the subacute and chronil stage. The purpose was to determine the predictive value of factor XIII deficiency regarding the recurrence rate and the incidence of postoperative complications. A factor XIII activity of > 70% activity is considered to be physiological.
Methods: We included patients after surgery (burr hole trepanation or craniotomy) for SDH. We excluded patients with acute subdural hematomas. Retrospective data assessment obtained the preoperative factor XIII activity, baseline characteristics (age, sex, oral anticoagulants and antiplatelet, co-morbidities), radiological findings (recurrence of SDH, postoperative acute subdural hematoma) and the neurological outcome (Glasgow Outcome Scale) on discharge. For the analysis we dichotomized the patients into two groups – chronical SDH and SDH in subacute stage.
Results: 165 patients with chronic/subacute subdural hematoma were treated from January 2018 until October 2019. We had a dropout of 54 patients due to missing laboratory examination of factor XIII activity in the preoperative setting. Ninety patients were treated for chronic SDH and 21 patients for subacute SDH. Twenty (18%) patients had a recurrence of the SDH with the need for surgery. Twelve (10%) patients developed a postoperative complication requiring surgery. In 22 (19%) patients the preoperative factor XIII activity was equal or less than 70%. In 3 (15%) of the patients with recurrence of the SDH, factor XIII activity was equal or less than 70%. In 5 (41%) of the patients with postoperative complications decreased factor XIII activity was measured. Before operation, 59 (52%) patients had oral anticoagulants or antiplatelet therapy.
Conclusion: Factor XIII deficiency is a common finding (19% of the patients) in the preoperative laboratory examination. Although it does not seem to play a role in the risk of recurrence of SDH, it does have an impact on the clinical course regarding postoperative complications.
