Artikel
Laboratory markers and risk of secondary haemorrhagic complications after anticoagulation due to venous thromboembolism in the early postoperative phase after neurosurgical procedures
Labormarker und Risiko von Nachblutungen durch Antikoagulation bei venösen thrombembolischen Ereignissen nach neurochirurgischen Eingriffen
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Veröffentlicht: | 25. Mai 2022 |
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Gliederung
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Objective: Deep venous thromboses (DVT) and venous thromboembolisms (VTE) are serious complications after neurosurgical procedures. On the other hand, hemorrhagic complications due to therapeutic anticoagulation are highly dreaded. Aim of the study was to determine patients at risk for a severe course of thrombosis and complications due to anticoagulation.
Methods: Over a 10-year episode, patients with a postoperative DVT or VTE were identified and demographic risk factors as well as routine laboratory coagulation parameters (pTT, platelet levels, Quick, D-dimer) were assessed
Results: From 25.256 operative neurosurgical cases 173 patients with a DVT or VTE were identified (0.7%) of which 80.9% occurred after craniotomy. Clinical effect of thrombosis was severe in 32.4% and course was fatal in 5.8%. Spinal surgery was associated with a major or fatal outcome of thrombosis as compared to cranial procedures. Elevated pTT, low platelet levels and low Quick on diagnosis of thrombosis were associated with a fatal clinical course.
Severe hemorrhagic complications requiring surgical management occurred in 6.6%, 0.6% were fatal. D-dimer did not predict the course of DVT/VTE but higher levels on day 3 after diagnosis of the thromboembolic event were associated with severe bleeding complications with a cut-off of 4.95µg/ml. PTT was not associated with hemorrhagic complications.
Conclusion: Patients with signs of consumption coagulopathy on diagnosis of DVT/VTE showed a worse clinical course. PTT might be a good parameter for monitoring unfractionated heparin therapy but not to determine the risk of bleeding complications during the early postoperative phase. D-dimer might be of additional use to detect early bleeding complications.