Review Article

Acta Neurochirurgica

, Volume 151, Issue 8, pp 873-900

First online:

Hemostatic and hemorrhagic problems in neurosurgical patients

  • Ruediger GerlachAffiliated withDepartment of Neurosurgery, Johann Wolfgang Goethe University Email author 
  • , Manuela KrauseAffiliated withDepartment of Medicine, DKD
  • , Volker SeifertAffiliated withDepartment of Neurosurgery, Johann Wolfgang Goethe University
  • , Klaus GoerlingerAffiliated withDepartment of Anaesthesiology and Intensive Care Medicine, University Essen

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Abnormalities of the hemostasis can lead to hemorrhage, and on the other hand to thrombosis. Intracranial neoplasms, complex surgical procedures, and head injury have a specific impact on coagulation and fibrinolysis. Moreover, the number of neurosurgical patients on medication (which interferes with platelet function and/or the coagulation systems) has increased over the past years.


The objective of this review is to recall common hemostatic disorders in neurosurgical patients on the basis of the “new concept of hemostasis”. Therefore the pertinent literature was searched to provide a structured and up to date manuscript about hemostasis in Neurosurgery.


According to recent scientific publications abnormalities of the coagulation system are discussed. Pathophysiological background and the rational for specific (cost)-effective perioperative hemostatic therapy is provided.


Perturbations of hemostasis can be multifactorial and maybe encountered in the daily practice of neurosurgery. Early diagnosis and specific treatment is the prerequisite for successful treatment and good patients outcome.


Hemorrhagic disorders Postoperative hemorrhage Coagulopathy Fibrinolysis DIC Thrombosis Head injury