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Hemostatic and hemorrhagic problems in neurosurgical patients

  • Review Article
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Abstract

Background

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.

Method

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.

Findings

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.

Conclusions

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.

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Acknowledgements

We thank Marina Eberhardt, Department of Neurosurgery Johann Wolfgang Goethe- University Frankfurt/Main for her valuable contribution in preparing the figures.

Financial disclosure

None of the authors has any financial interest in the methodology being advanced with the publication of our manuscript. The authors Ruediger Gerlach* and Klaus Goerlinger** point out that they held several scientific lectures on fee basis for the following companies: CSL Behring (*;**) GmbH (Marburg, Germany), Instrumentation Laboratory (**) (Kirchheim, Germany), Novo Nordisk Pharma GmbH (*;**)(Mainz, Germany), Pentapharm GmbH (**)(Munich, Germany). Content and presentation of the publication has not been influence by these associations.

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Authors and Affiliations

  1. Department of Neurosurgery, Johann Wolfgang Goethe University, Schleusenweg 2-16, 60528, Frankfurt am Main, Germany

    Ruediger Gerlach & Volker Seifert

  2. Department of Medicine, DKD, Aukammallee 33, 65191, Wiesbaden, Germany

    Manuela Krause

  3. Department of Anaesthesiology and Intensive Care Medicine, University Essen, Hufelandstrasse 55, 45122, Essen, Germany

    Klaus Goerlinger

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  1. Ruediger Gerlach
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Correspondence to Ruediger Gerlach.

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Comment

This is a major and very up-to-date overview about hemostatic and hemorrhagic disorders and problems encountered in neurosurgical disease and procedures. It also covers very nicely the postoperative problems, for example in the ICU, and gives clues for preoperative easy evaluation. It may turn out to become a very valuable reference paper in neurosurgical wards, with guidelines highlighted on plastic cards for daily use. Very recent developments are also covered, like the use of rF VII, including costs and cost-effectiveness. The authors give strong arguments for the routine use of modern test equipment like the ROTEM and the Multiplate test. In the subchapters, the reader can find all the necessary information on most if not all details one should like to know about specific situations. The bottom line is: the variety in the clotting and its disturbances is large, and the right tests should be used for the right things. Recommendable, especially for the education and training of residents, and not only in neurosurgery!

Janjakob Mooij

Academische Ziekenhuis Groningen,

Netherlands

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Gerlach, R., Krause, M., Seifert, V. et al. Hemostatic and hemorrhagic problems in neurosurgical patients. Acta Neurochir 151, 873–900 (2009). https://doi.org/10.1007/s00701-009-0409-z

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