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Fibrinogen but not factor XIII deficiency is associated with bleeding after craniotomy.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Adelmann, D. Klaus, D. A. Illievich, U. M. Krenn, C. G. Krall, C. Kozek-Langenecker, S. Schaden, E.
Description	Author Affiliation: Adelmann D ( Department of Anesthesiology, General Intensive Care and Pain Control and.); Klaus DA ( Department of Anesthesiology, General Intensive Care and Pain Control and.); Illievich UM ( Department of Anesthesiology and Intensive Care, Landes-Nervenklinik Wagner-Jauregg, Linz, Austria.); Krenn CG ( Department of Anesthesiology, General Intensive Care and Pain Control and.); Krall C ( Section for Medical Statistics, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.); Kozek-Langenecker S ( Department of Anaesthetics and Intensive Care, Evangelical Hospital Vienna, Vienna, Austria.); Schaden E ( Department of Anesthesiology, General Intensive Care and Pain Control and eva.schaden@meduniwien.ac.at.)
Abstract	BACKGROUND: Postoperative haemorrhage in neurosurgery is associated with significant morbidity and mortality. There is controversy whether or not factor XIII (FXIII) deficiency leads to bleeding complications after craniotomy. Decreased fibrinogen levels have been associated with an increased incidence of bleeding complications in cardiac and orthopaedic surgery. The aim of this study was to assess perioperative fibrinogen and FXIII levels in patients undergoing elective intracranial surgery with and without severe bleeding events. METHODS: Perioperative FXIII and fibrinogen levels were prospectively assessed in 290 patients undergoing elective craniotomy. Patients were divided into two groups according to the presence or absence of severe bleeding requiring surgical revision. Coagulation test results of these groups were compared using Student's t-test. RESULTS: The incidence of postoperative severe bleeding was 2.4%. No differences in FXIII levels were observed, but postoperative fibrinogen levels were significantly lower in patients suffering from postoperative haematoma compared with those without postoperative intracranial bleeding complications [237 mg dl(-1) (standard deviation, SD 86) vs 170 mg dl(-1) (SD 35), P=0.03]. The odds ratio for postoperative haematoma in patients with a postoperative fibrinogen level below 200 mg dl(-1) was 10.02 (confidence interval: 1.19-84.40, P=0.03). CONCLUSIONS: This study emphasizes the role of fibrinogen as potentially modifiable risk factor for perioperative bleeding in intracranial surgery. Future randomized controlled trials will be essential to identify patients who might benefit from fibrinogen substitution during neurosurgical procedures.
File Format	HTM / HTML
ISSN	00070912
e-ISSN	14716771
Journal	British Journal of Anaesthesia
Issue Number	4
Volume Number	113
Language	English
Publisher	Oxford University Press
Publisher Date	2014-10-01
Publisher Place	Great Britain (UK)
Access Restriction	Open
Subject Keyword	Discipline Anesthesiology Afibrinogenemia Complications Coagulation Protein Disorders Craniotomy Adverse Effects Factor Xiii Postoperative Hemorrhage Epidemiology Etiology Adolescent Blood Coagulation Tests Confidence Intervals Fibrinogen Metabolism Therapeutic Use Neurosurgical Procedures Odds Ratio Partial Thromboplastin Time Platelet Count Prospective Studies Roc Curve Observational Study
Content Type	Text
Resource Type	Article
Subject	Anesthesiology and Pain Medicine

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