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Platelets and neurosurgery

Megan Anders, Peter Rock, Alex Cartron, Jonathan Chow, Reney Henderson, Douglas Martz, Kenichi Tanaka, Michael Mazzeffi
BACKGROUND: Surgical patients receive platelet concentrates (PCs) for a variety of indications. However, there is limited evidence for efficacy or dosing of PCs. STUDY DESIGN AND METHODS: We performed a retrospective cohort study of surgical patients receiving isolated PC transfusion at a single academic tertiary medical center during 1 year. The primary outcome was reoperation for a bleeding complication. Bleeding complication rates were compared in patients transfused for different indications, and multivariable logistic regression was performed to determine variables associated with bleeding complications...
January 29, 2019: Transfusion
George M Rodgers
Normal hemostasis provides for balanced interactions between the blood vessel wall, coagulation proteins, and platelets. After vascular injury, primary hemostasis and secondary hemostasis function in a coordinated fashion to stop bleeding. Standard coagulation tests have been shown in multiple studies to predict bleeding and mortality in neurosurgical patients. Emerging coagulation tests are useful point-of-care assays that guide transfusion therapy and diagnose patients with hyperfibrinolysis. This article provides an overview of hemostasis, a summary of standard coagulation testing and point-of-care tests, and a brief review of coagulation test usefulness in neurosurgery, focusing on studies in patients with traumatic brain injury...
October 2018: Neurosurgery Clinics of North America
Yoshinori Maki, Yoshitaka Kurosaki, Kaori Uchino, Ryota Ishibashi, Masaki Chin, Sen Yamagata
BACKGROUND: Pituitary apoplexy (PA) is a life-threatening syndrome. The usage of a dopamine agonist, such as bromocriptine or cabergoline, is considered a predisposing factor for PA, which commonly occurs 1.5 years within commencement. CASE DESCRIPTION: A 64-year-old female with a >15-year history of cabergoline therapy for pituitary prolactinoma was referred to our department of neurosurgery after complaining of headache, blurred vision, diplopia, and ptosis for 3 days during hospital admission for chemotherapy of chronic myelocytic leukemia...
December 2018: World Neurosurgery
Tom Theys, Anais Van Hoylandt, Charlotte-Elise Broeckx, Laura Van Gerven, Joyce Jonkergouw, Marc Quirynen, Johannes van Loon
BACKGROUND: Cerebrospinal fluid (CSF) leakage represents an important and sometimes challenging complication in both cranial and spinal surgery. Current available options for dural closure pose inherent problems regarding safety, efficacy, immunogenicity, cost, and invasiveness. In this article, the use of leukocyte- and platelet-rich fibrin (L-PRF) derived from the patient's own blood is proposed to facilitate dural closure. We aim to describe the safety, feasibility, and applicability of L-PRF membranes and plugs in cranial and spinal neurosurgery...
June 6, 2018: Acta Neurochirurgica
Nitesh P Patel, Kristopher A Lyon, Jason H Huang
Peripheral nerve injuries (PNI) are caused by a range of etiologies and result in a broad spectrum of disability. While nerve autografts are the current gold standard for the reconstruction of extensive nerve damage, the limited supply of autologous nerve and complications associated with harvesting nerve from a second surgical site has driven groups from multiple disciplines, including biomedical engineering, neurosurgery, plastic surgery, and orthopedic surgery, to develop a suitable or superior alternative to autografting...
May 2018: Neural Regeneration Research
A Kisilevsky, A W Gelb, M Bustillo, A M Flexman
Both anaemia and blood transfusion are associated with poor outcomes in the neurosurgical population. Based on the available literature, the optimal haemoglobin concentration for neurologically injured patients appears to be in the range of 9.0-10.0 g dl-1 , although the individual risks and benefits should be weighed. Several perioperative blood conservation strategies have been used successfully in neurosurgery, including correction of anaemia and coagulopathy, use of antifibrinolytics, and intraoperative cell salvage...
May 2018: British Journal of Anaesthesia
Nicholas J Goel, Kalil G Abdullah, Omar A Choudhri, David K Kung, Timothy H Lucas, H Isaac Chen
BACKGROUND: The association between underlying liver disease and poor surgical outcomes has been well documented across a wide variety of surgical disciplines. However, little is known about the importance of liver disease in neurosurgery. In this report, we assess the independent effect of liver disease on perioperative outcomes in patients undergoing craniotomy for tumor. METHODS: The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was queried for patients undergoing craniotomy for tumor from 2006 to 2015...
July 2018: World Neurosurgery
Ahmad Oryan, Soodeh Alidadi, Amin Bigham-Sadegh, Ali Moshiri
Polymethylmethacrylate (PMMA) is the most commonly used filler material that lacks biological properties and osteoconductivity or osteoinductivity. Platelet gel (PG) is a typical source of growth factors, cytokines and molecules efficient for bone formation and remodeling. The aim of this study was to evaluate bone healing and regeneration of bone defect in rat model by combining PMMA with PG. A total of 50 defects were created in the diaphysis of the radii of 25 male Sprague-Dawley rats. These defects were randomly divided into five groups (n = 10 defects for each group) and treated by autograft, plain PMMA, PG and PMMA-PG or left untreated...
2018: PloS One
Dominik Baschera, Joachim Oberle, Florian Grubhofer, Samuel Luca Schmid
BACKGROUND AND STUDY AIMS:  Perioperative use of anticoagulant and platelet-inhibiting agents by patients undergoing spine surgery poses the dilemma of increased risk of hemorrhage. We examined the standards of use for these medications and expert opinions through a nationwide survey. MATERIALS AND METHODS:  An online-based survey was conducted by invitation. A personal token to access the survey was sent to one representative of each neurosurgical and orthopaedic unit performing spine surgery and to all other active members of the Swiss Society of Neurosurgery and the Swiss Society of Spinal Surgery...
September 2018: Journal of Neurological Surgery. Part A, Central European Neurosurgery
Qiang Yuan, Jian Yu, Xing Wu, Yi-Rui Sun, Zhi-Qi Li, Zhuo-Ying Du, Xue-Hai Wu, Jin Hu
BACKGROUND: Coagulopathy is commonly observed after traumatic brain injury (TBI). However, it is not known whether using the standard independent predictors in conjunction with coagulation tests would improve their prognostic value. We determined the incidence of TBI-associated coagulopathy in patients with isolated TBI (iTBI), evaluated the prognostic value of coagulation tests for in-hospital mortality, and tested their predictive power for in-hospital mortality in patients with iTBI...
January 5, 2018: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
Kazutaka Sugimoto, Hideyuki Ishihara, Mizuya Shinoyama, Hirokazu Sadahiro, Michiyasu Suzuki
BACKGROUND: A recent randomized control study(the PATCH trial)found no beneficial effect of platelet concentrate(PC)transfusion on the prognosis of patients with intracerebral hemorrhage(ICH)treated with anti-platelet agents(APAs). However, the trial excluded surgical cases. In this study, we examined the effect of PC on ICH, including patients who received surgical treatment. METHOD: A retrospective cohort analysis was performed in 23(11 males, 12 females)of 35 patients diagnosed with ICH and treated with APAs between January 2010 and December 2015 at the Department of Neurosurgery, Yamaguchi University Hospital...
November 2017: No Shinkei Geka. Neurological Surgery
Carl Marincowitz, Fiona Lecky, William Townend, Aditya Borakati, Trevor Sheldon
BACKGROUND: The optimal management of minor head injured patients with brain injury identified by CT imaging is unclear. Some guidelines recommend routine hospital admission of GCS13-15 patients with traumatic brain (TBI) injury identified by CT imaging. Others argue that selected lower-risk patients can be discharged from the Emergency Department (ED). OBJECTIVE: To estimate the risk of death, neurosurgery and clinical deterioration minor head injured patients with TBI identified by CT imaging, and assess which factors affect the risk of these outcomes...
December 2017: Emergency Medicine Journal: EMJ
Marta Lopes, Bruno Carvalho, Rui Vaz, Paulo Linhares
Neutrophil-lymphocyte ratio (NLR) is a hematological marker of systemic inflammation and several studies demonstrate an association between a higher NLR and a worse prognosis in many malignancies. However, literature analyzing its prognostic value in glioblastoma multiforme (GBM) is still scarce. We intended to analyze the correlation of NLR with overall survival and progression-free survival in patients with GBM performing a retrospective review of the patients with diagnosis of GBM submitted to a resection surgery in the department of neurosurgery of a tertiary care hospital, between January/2005 and January/2013...
January 2018: Journal of Neuro-oncology
Christoph Ellenberger, Najia Garofano, Gleicy Barcelos, John Diaper, Gordana Pavlovic, Marc Licker
BACKGROUND: Rotational elastometry (ROTEM) has been shown useful to monitor coagulation in trauma patients and in major elective surgery. In this study, we aimed to evaluate the utility of ROTEM to identify hemostatic disturbances and to predict the need for transfusion, compared with standard coagulation tests (SCTs) in patients undergoing emergent neurosurgery. METHODS: Over a four-year period, adult patients who met criteria for emergent neurosurgery lasting more than 90 min were included in the study...
October 24, 2017: BMC Anesthesiology
M Kotru, S S Munjal, M Singh, T Seth, H P Pati
Neurosurgical patients with suspected DIC receive large amount of transfusion support in form of red cell concentrates (RCC), platelet rich plasma (PRP) and fresh frozen plasma (FFP). However, there are very few studies which have studied the effect of blood components load in the outcome of the patient. We conducted a prospective observational study on 61 post operative neurosurgery patients suspected with DIC and had at least one deranged haemostatic parameter namely platelet count, prothrombin time, partial thromboplastin time and thrombin time...
September 2017: Indian Journal of Hematology & Blood Transfusion
M Baschin, S Selleng, J-P Zeden, A Westphal, T Kohlmann, H W Schroeder, A Greinacher, T Thiele
BACKGROUND: Platelet concentrates (PC) are transfused to improve primary haemostasis before urgent neurosurgery in patients with intracranial haemorrhage (ICH) receiving antiplatelet therapy (APT). It is unresolved, whether PCs increase the risk for major cardio- and cerebrovascular adverse events. We evaluated a standardized transfusion regimen to reverse APT in patients with ICH who required decompressive neurosurgery. METHODS: Analysed were consecutive patients between 2012 and 2014...
August 2017: Vox Sanguinis
Daphne Li, Taylor Glor, G Alexander Jones
INTRODUCTION: The absence of evidence-based guidelines for platelet transfusion surrounding invasive neurosurgical procedures leads to uncertainty in management. Multiple studies have illuminated this lack of high quality data, and subsequent reliance on expert opinion. The generally accepted threshold for platelet transfusion has hovered around 100,000/μL. METHODS: We have conducted a review of available clinical literature to identify any evidence that may support or refute these general guidelines, in an attempt to clarify the need for platelet transfusion in the patient requiring neurosurgical intervention...
October 2017: World Neurosurgery
E Silverberg, F Tornqvist, T Kander, J Bengzon, C Solomon, J Bonnevier, U Schött
BACKGROUND: Previous viscoelastic haemostatic tests studies have often indicated a hypercoagulative test signal with citrated blood, which could influence clinical decision makings. PURPOSE: The aim of this study was to compare fresh and citrated whole blood using two non-automated viscoelastic ROTEM and Sonoclot tests. Our hypothesis was that citrated blood would demonstrate a hypercoagulative response in this setting, not tested before. METHODS: Perioperative viscoelastic coagulation changes were evaluated with a ROTEM and Sonoclot in 38 patients undergoing elective brain tumor surgery...
August 2017: Thrombosis Research
Alex T Lee, Arni Gagnidze, Sharon R Pan, Pimwan Sookplung, Bala Nair, Shu-Fang Newman, Alon Ben-Ari, Ahmed Zaky, Kevin Cain, Monica S Vavilala, Irene Rozet
BACKGROUND: Antiplatelet medications are usually discontinued before elective neurosurgery, but this is not an option for emergent neurosurgery. We performed a retrospective cohort study to examine whether preoperative aspirin use was associated with worse outcomes after emergency neurosurgery in elderly patients. METHODS: We analyzed all cases of emergency neurosurgical procedures for traumatic intracranial hemorrhage from 2008 to 2012 at a level 1 trauma center...
August 2017: Anesthesia and Analgesia
David Dornbos, Joel S Katz, Patrick Youssef, Ciarán J Powers, Shahid M Nimjee
Thromboembolic complications remain a major risk of endovascular neurosurgery during the treatment of intracranial aneurysms, despite the use of therapeutic heparinization and oral antiplatelet therapy when indicated. Glycoprotein (GP) IIb/IIIa inhibitors target a nonredundant pathway of platelet aggregation following adhesion and activation. Initially established and implemented in the cardiovascular arena, this drug class has provided a new tool in the neurovascular armamentarium as well. Numerous case reports, case series, and retrospective reviews have evaluated the safety and efficacy of abciximab, eptifibatide, and tirofiban in the treatment of acute thromboembolic complications during the endovascular treatment of intracranial aneurysms...
March 1, 2018: Neurosurgery
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