Effectiveness of Coagulation Profile as a marker for blood loss in Elective Craniotomy patients

  • Naveed Zaman Akhunzada Rehman Medical Institute, Peshawer
  • Saad Bin Anis Shoukat Khanum Memorial Cancer Hospital and Research Center, Lahore.
  • Saad Akhtar Khan
  • Badar Uddin Ujjan DOW University of Health Sciences, Karachi.
Keywords: Elective Craniotomy, coagulation profiles.

Abstract

Objective: The objective of this study is to determine the role of preoperative coagulation studies in predicting intraoperative blood loss, in patients undergoing elective craniotomy in our tertiary hospital setting.
Materials and Methods: This was a Quasi-experimental study conducted at Department of Neurosurgery, Aga Khan University Hospital Karachi for a duration of 6 months. A non-probability consecutive sampling technique was employed. All admitted neurosurgery patients for elective craniotomy were enrolled and followed as part of the study. Laboratory values including baseline workup e.g. Complete Blood count, PT, activated Partial Thromboplastin Time (aPTT), Internationalized Ratio (INR) were taken preoperatively and postoperatively. A predesigned questionnaire for the collection of data was used, which included demographics and clinical information. Approval from the university ethical committee was obtained before starting the study. Data was entered and analysed into SPSS version 21. Effect modifier age, gender, co-morbids, type, and duration of surgery, were controlled through stratification. Post-stratification paired t-test and independent-sample t-test were applied using P ≤ 0.05 as significant.
Results: In this study 57 patients who underwent elective craniotomy were included to assess the mean blood loss and to compare mean blood loss in patients with normal and deranged coagulation profiles. The mean age of patients included in the study was 39.36±13.94 years with 43 (75.4%) males and 14 (24.6%) females. The mean preoperative haemoglobin level amongst all patients turned out to be 14.10±3.98 gm/dl. The postoperative haemoglobin level showed a decrease with a mean of 12.68±31.98 gm/dl. Therefore the mean difference calculated between pre and post-operative haemoglobin levels turned out to be 1.42±0.99 gm/dl.
Conclusion: It is to be concluded that significant change was found in preoperative and post-operative Haemoglobin levels in patients undergoing elective craniotomy. There was also a highly significant difference in blood loss between patients having a normal versus deranged coagulation profile. However, there is a need to conduct more studies using a large sample size with multiple study sites in Pakistan to validate these results.

References

1. Burchiel KJ: Editorial. International normalized ratio. JNeurosurg. 2011; 114:8. DOI: https://doi.org/10.3171/2010.3.JNS10155
2. Asaf T, Reuveni H, Yermiahu T, Leiberman A, Gurman G, Porat A, et al. The need for routine pre-operative coagulation screening tests (prothrombin time PT/partial thromboplastin time PTT) for healthy children undergoing elective tonsillectomy and/or adenoidectomy. Int J Pediatr Otorhinolaryngol. 2001; 61 (3):217-22. https://doi.org/10.1016/S0165-5876(01)00574-2
3. Eisenberg JM, Clarke JR, Sussman SA. Prothrombin and partial thromboplastin times as preoperative screening tests. Arch Surg. 1982; 117(1): 48-51. DOI: https://doi.org/10.1001/archsurg.1982.01380250030007
4. Martin JH, Rosser CJ, Linebach RF, McCullough DL, Assimos DG. Are coagulation studies necessary before percutaneous nephrostomy?. Tech Urol. 2000; 6(3):205-7. https://doi.org/10.1016/s0090-4295(99)00457-4
5. Ng KF, Lai KW, Tsang SF. Value of preoperative coagulation tests: reappraisal of major noncardiac surgery. World J Surg. 2002;26(5):515-20. https://doi.org/10.1007/s00268-001-0260-8
6. Rohrer MJ, Michelotti MC, Nahrwold DL. A prospective evaluation of the efficacy of preoperative coagulation testing. Ann Surg. 1988;208(5):554. https://doi.org/10.1097/00000658-198811000-00002
7. Suchman AL, Mushlin Al. How well does the activated partial thromboplastin time predict postoperative hemorrhage?. JAMA. 1986;256(6):750-3. https://doi.org/10.1001/jama.1986.03380060076029
8. Schramm B, Leslie K, Myles PS, Hogan CJ. Coagulation studies in preoperative neurosurgical patients. Anaesth Intensive care. 2001;29(4):388 https://doi.org/10.1177/0310057x0102900410
9. Matevosyan K, Madden C, Barnett SL, Beshay JE, Rutherford C, Sarode R. Coagulation factor levels in neurosurgical patients with mild prolongation of prothrombin time: effect on plasma transfusion therapy. JNeurosurg. 2011;114: 3-7. https://doi.org/10.3171/2010.7.jns091699
10. Perez A, Planell J, Bacardaz C, Hounie A, Franci J, Brotons C, et al. Value of routine preoperative tests: a multicentre study in four general hospitals. Br J Anaesth. 1995;74:250-256. https://doi.org/10.1093/bja/74.3.250
11. Seicean A, Schiltz NK, Seicean S, Alan N, Neuhauser D, Weil RJ. Use and utility of preoperative hemostatic screening and patient history in adult neurosurgical patients: Clinical article. JNeurosurg. 2012; 116(5): 1097-105. https://doi.org/10.3171/2012.1.jns111760
12. McCormick WF, Rosenfield DB: Massive brain hemorrhage: a review of 144 cases and an examination of their causes. Stroke. 1973;4:946-954. https://doi.org/10.1161/01.str.4.6.946
13. Diitzmann S, GeBler F, Marquardt G, Seifert V, Senft C. On the value of routine prothrombin time screening in elective neurosurgical procedures. Neurosurg Focus. 2012;33(5): E9. Genecov DG, Por YC, Barcelo CR, Salyer KE, Mulne AF, Morad AB. Preoperative screening for coagulopathy using prothrombin time and partial thromboplastin time in patients requiring primary cranial vault remodeling. Plast Reconstr Surg. 2005;116(2):389-94. https://doi.org/10.1097/01.prs.0000172760.79803.68
14. Fearon JA, Weinthal J. The use of recombinant erythropoietin in the reduction of blood transfusion rates in craniosynostosis repair in infants and children. Plast Reconstr Surg. 2002;109:2190–6. https://doi.org/10.1097/00006534-200206000-00002
15. Meneghini L, Zadra N, Aneloni V, Metrangolo S, Faggin R, Giusti F. Erythropoietin therapy and acute preoperative normovolaemic haemodilution in infants undergoing craniosynostosis surgery. Paediatr Anesth. 2003;13:392–6. https://doi.org/10.1046/j.1460-9592.2003.01091.x
16. Dunn CJ, Goa KL. Tranexamic acid: A review of its use in surgery and other indications. Drugs. 1999;57:1005–32. https://doi.org/10.2165/00003495-199957060-00017
17. Aguilera X, Videla S, Almenara M, Fernandez JA, Gich I, Celaya F. Effectiveness of tranexamic acid in revision total knee arthroplasty. Acta Orthop Belg. 2012;78:68–74. https://doi.org/10.1186/isrctn43363116
18. Rostami, E., et al., The terminal pathway of the complement system is activated in focal penetrating but not in mild diffuse traumatic brain injury. J Neurotrauma, 2013. 30(23): p. 1954-65. https://doi.org/10.1089/neu.2012.2583
19. Bellander, B.M., et al., Secondary insults following traumatic brain injury enhance complement activation in the human brain and release of the tissue damage marker S100B. Acta Neurochir (Wien), 2011. 153(1): p. 90-100. https://doi.org/10.1007/s00701-010-0737-z
20. Zipfel, G.J., et al., Neuronal apoptosis after CNS injury: the roles of glutamate and calcium. J Neurotrauma, 2000. 17(10): p. 857-69. https://doi.org/10.1089/neu.2000.17.857
21. Conti, A.C., et al., Experimental brain injury induces regionally distinct apoptosis during the acute and delayed post-traumatic period. J Neurosci, 1998. 18(15): p. 5663-72. https://doi.org/10.1523/jneurosci.18-15-05663.1998
22. Green, D.R. and J.C. Reed, Mitochondria and apoptosis. Science, 1998. 281(5381): p. 1309-12. https://doi.org/10.1126/science.281.5381.1309
23. Cheng, G., et al., Mitochondria in traumatic brain injury and mitochondrial-targeted multipotential therapeutic strategies. Br J Pharmacol, 2012. 167(4): p. 699-719. https://doi.org/10.1111/j.1476-5381.2012.02025.x
24. Reilly, P., Bullock R., Head Injury, pathophysiology and management. 2005. Hodder Arnold(second edition): p. 129-130. https://doi.org/10.1201/b13492
25. Bonfoco, E., et al., Apoptosis and necrosis: two distinct events induced, respectively, by mild and intense insults with N-methyl-D-aspartate or nitric oxide/superoxide in cortical cell cultures. Proc Natl Acad Sci U S A, 1995. 92(16): p. 7162-6. https://doi.org/10.1073/pnas.92.16.7162
26. Stein, S.C. and D.H. Smith, Coagulopathy in traumatic brain injury. Neurocrit Care, 2004. 1(4): p. 79-88. https://doi.org/10.1385/ncc:1:4:479
27. Epstein, D.S., et al., Acute traumatic coagulopathy in the setting of isolated traumatic brain injury: Definition, incidence and outcomes. Br J Neurosurg, 2014: p. 1-5. https://doi.org/10.1016/j.injury.2014.01.011
28. Deogaonkar A, De Georgia M, Mascha E, Todd M, Schubert A IHAST Investigators. Intraoperative blood loss is associated with worse outcome after aneurysmal subarachnoid hemorrhage. J Neurosurg Anesthesiol. 2006;18:302–3. https://doi.org/10.1097/00008506-200610000-00073
Published
2021-03-30
How to Cite
1.
Akhunzada N, Anis S, Khan S, Ujjan B. Effectiveness of Coagulation Profile as a marker for blood loss in Elective Craniotomy patients. JRMC [Internet]. 30Mar.2021 [cited 5Aug.2021];25(1):31-6. Available from: https://journalrmc.com/index.php/JRMC/article/view/1369