Evaluation of perioperative coagulation in patients undergoing brain and spine surgery

Alev Atalay; Abdurrahim Derbent; Mustafa Nuri Deniz; Sezgin Ulukaya; Sacittin Taner Balcioğlu

doi:10.19161/etd.1627445

EN TR

Evaluation of perioperative coagulation in patients undergoing brain and spine surgery

Abstract

Aim: Conditions during brain and spine surgery, such as trauma, surgery, general anesthesia, fluid infusions, hypothermia, and patient inactivity, may lead to coagulation disorders, increasing the risk of bleeding or thrombosis. This study aimed to evaluate the relationship between thromboelastography (TEG), coagulation, and perioperative transfusion. Materials and Methods: In 2012, 58 adult ASA I–III patients undergoing brain and spine surgery were prospectively included after obtaining ethics committee approval and patient consent. Patients with coagulopathy or anticoagulants were excluded. Fluid requirements were managed with balanced crystalloids, and selected patients were randomly administered 6% hydroxyethyl starch or 4% gelatin solutions. Coagulation was monitored preoperatively, at the end of surgery, and 24 hours postoperatively using TEG and standard coagulation parameters. Results: The mean age of the patients was 46.7 years, the mean BMI was 27.7, and 62.1% were female. Eleven patients (18.9%) required an average of 6.1 (±4.1) mL/kg erythrocyte transfusion. Transfused patients had longer operative times (p=0.022), anesthesia durations (p=0.014), total fluid requirements (p<0.001), and crystalloid infusions (p=0.039). TEG data revealed no coagulation abnormalities causing clinical bleeding. However, postoperative Maximum Amplitude (MA) significantly increased in both groups. MA showed a positive correlation with age (r=0.27, p=0.039) and crystalloid volume (r=0.29, p=0.027), and a negative correlation with the lowest temperature (r=-0.28, p=0.029). Coagulation Index (CI) was positively correlated with preoperative fibrinogen levels (r=0.28, p=0.045). Conclusion: TEG analysis showed similar coagulation profiles in transfused and non-transfused patients. Before drawing general conclusions about perioperative coagulation, these findings should be compared with studies using restrictive transfusion protocols.

Keywords

Beyin ve omurga cerrahisi geçiren hastalarda perioperatif koagülasyonun değerlendirilmesi

Öz

Amaç: Beyin ve omurga cerrahisi sırasında travma, cerrahi, genel anestezi, sıvı infüzyonları, hipotermi ve hastanın hareketsizliği koagülasyon bozukluklarına yol açarak kanama veya tromboz riski oluşturabilir. Bu çalışmada, trombelastografi (TEG) kullanılarak koagülasyon, perioperatif kanama ve transfüzyon arasındaki ilişki değerlendirildi. Yöntemler: Etik kurul onayı ve hasta onamı alındıktan sonra, 2012 yılında beyin ve omurga cerrahisi geçiren 58 yetişkin ASA I–III hasta prospektif olarak çalışmaya dahil edildi. Koagülopatisi veya antikoagülan kullanan hastalar dışlandı. Sıvı ihtiyacı dengeli kristalloidlerle karşılandı; rastgele seçilen hastalarda %6 hidroksietil-starch veya %4 jelatin solüsyonları kullanıldı. Koagülasyon, cerrahi öncesinde, sonunda ve 24 saat sonrasında TEG ve standart koagülasyon parametreleri ile takip edildi. Bulgular: Hastaların yaş ortalaması 46,7, BMI ortalaması 27,7 olup %62,1’i kadındı. Transfüzyon gerektiren 11 hastaya ortalama 6,1 (±4,1) mL/kg eritrosit verildi. Bu hastalarda operasyon süresi (p=0,022), anestezi süresi (p=0,014), toplam sıvı (p<0,001) ve kristalloid infüzyon miktarı (p=0,039) daha fazlaydı. TEG verilerine göre klinik kanamaya yol açacak koagülasyon anormalliği saptanmadı. Ancak, her iki grupta da postoperatif Maksimum Amplitüd (MA) anlamlı şekilde arttı. MA, yaş (r=0,27, p=0,039) ve kristalloid miktarı (r=0,29, p=0,027) ile pozitif; en düşük sıcaklık değeri ile negatif (r=-0,28, p=0,029) korelasyon gösterdi. Ayrıca Koagülasyon İndeksi (CI) preoperatif fibrinojen seviyesi ile pozitif korelasyon gösterdi (r=0,28, p=0,045). Sonuç: TEG analizleri, transfüzyon yapılan ve yapılmayan hastalarda koagülasyon profillerinin benzer olduğunu ortaya koydu. Perioperatif koagülasyon sürecine ilişkin genel kararlar vermeden önce, sonuçlarımızın restriktif transfüzyon rejimleri uygulanan çalışmalarla karşılaştırılması gerekmektedir.

Anahtar Kelimeler

References

Zhou JJ, Hemphill C, Walker CT, Farber SH, Uribe JS. Adverse Effects of Perioperative Blood Transfusion in Spine Surgery. World Neurosurg. 2021;149:73–9.
Şeref O. İntrakarniyal kitle cerrahisinde desfluran ve izofluran anestezisinin hemostalik sistem üzerine olan etkilerinin tromboelstografi yöntemi ile değerlendirilmesi [İnternet]. Vol. 36. 2008 [cited 2024 Dec 13]. p. 45–50. Available from: https://search.trdizin.gov.tr/tr/yayin/detay/78575/intrakarniyal-kitle-cerrahisinde-desfluran-ve-izofluran-anestezisinin-hemostalik-sistem-uzerine-olan-etkilerinin-tromboelstografi-yontemi-ile-degerlendirilmesi?view=bibtex&download=78575.bib
Miller RD, Stoelting RK. Hemostasis. In: Basics of Anesthesia (text only) 5th (Fifth) edition. 5th edition. Philadelphia, PA: Elsevier; 2007. p. 331–46.
Bhalerao PM. Perioperative Coagulopathies and Management. Indian J Clin Anaesth. 2015;2(3):173.
Ulukaya S, Alper I, Balcıoğlu ST. %6 hidroksietil nişasta (130/0.4) ve %4 süksinilli jelatin solüsyonlarının koagülasyona etkileri [İnternet]. Vol. 37. 2009 [cited 2025 Jan 23]. p. 280–6. Available from: https://search.trdizin.gov.tr/en/yayin/detay/93994
Carson JL, Stanworth SJ, Dennis JA, et al. Transfusion thresholds for guiding red blood cell transfusion. Cochrane Database Syst Rev. 2021;2021(12):CD002042.
Picard J, Bouzat P, Francony G, Payen JF, Schoettker P. Perioperative Hemostasis in Neurosurgery. In: Marcucci CE, Schoettker P, editors. Perioperative Hemostasis: Coagulation for Anesthesiologists [Internet]. Berlin, Heidelberg: Springer; 2015 [cited 2024 Dec 10]. p. 331–50. Available from: https://doi.org/10.1007/978-3-642-55004-1_19
Scarpelini S, Rhind SG, Nascimento B, et al. Normal range values for thromboelastography in healthy adult volunteers. Braz J Med Biol Res Rev Bras Pesqui Medicas E Biol. 2009;42(12):1210–7.

Atalan Özlen N, Arsan S, Cı̇velek A, et al. Tromboelastografi ve kalp cerrahisinde kullanımı. Anadolu Kardiyol Derg. 2008;8(2):154–62.
Lin YM, Yu C, Xian GZ. Calculation methods for intraoperative blood loss: a literature review. BMC Surg. 2024;24(1):1–10.
Martini J, Maisch S, Pilshofer L, Streif W, Martini W, Fries D. Fibrinogen concentrate in dilutional coagulopathy: a dose study in pigs. Transfusion (Paris). 2014;54(1):149–57.
Winstedt D, Tynngård N, Olanders K, Schött U. Free oscillation rheometry monitoring of haemodilution and hypothermia and correction with fibrinogen and factor XIII concentrates. Scand J Trauma Resusc Emerg Med. 2013 Mar 22;21(1):20.
Ng KFJ. Changes in thrombelastograph variables associated with aging. Anesth Analg. 2004;99(2):449–54, table of contents.
Sucker C, Tharra K, Litmathe J, Scharf R, Zotz R. Rotation thromboelastography (ROTEM) parameters are influenced by age, gender, and oral contraception. Perfusion. 2011;26(4):334–40.
Ao H, Moon JK, Tashiro M, Terasaki H. Delayed platelet dysfunction in prolonged induced canine hypothermia. Resuscitation. 2001;51(1):83–90.
Martini WZ. The effects of hypothermia on fibrinogen metabolism and coagulation function in swine. Metabolism. 2007;56(2):214–21.
Taggart R, Austin B, Hans E, Hogan D. In vitro evaluation of the effect of hypothermia on coagulation in dogs via thromboelastography: Hypothermia and coagulopathy. J Vet Emerg Crit Care. 2012;22(2):219–24.
Jones SB, Whitten CW, Despotis GJ, Monk TG. The influence of crystalloid and colloid replacement solutions in acute normovolemic hemodilution: a preliminary survey of hemostatic markers. Anesth Analg. 2003;96(2):363–8.
Ruttmann TG, James MF, Aronson I. In vivo investigation into the effects of haemodilution with hydroxyethyl starch (200/0.5) and normal saline on coagulation. Br J Anaesth. 1998;80(5):612–6.
Egli GA, Zollinger A, Seifert B, Popovic D, Pasch T, Spahn DR. Effect of progressive haemodilution with hydroxyethyl starch, gelatin and albumin on blood coagulation. Br J Anaesth. 1997;78(6):684–9.
Ruttmann TG, James MFM, Finlayson J. Effects on coagulation of intravenous crystalloid or colloid in patients undergoing peripheral vascular surgery. Br J Anaesth. 2002;89(2):226–30.
Boyd CJ, Brainard BM, Smart L. Intravenous Fluid Administration and the Coagulation System. Front Vet Sci [Internet]. 2021 Apr 15 [cited 2024 Dec 12];8. Available from: https://www.frontiersin.org/journals/veterinary-science/articles/10.3389/fvets.2021.662504/full
Hahn RG, Lyons G. The half-life of infusion fluids. Eur J Anaesthesiol. 2016;33(7):475–82.
Tuman KJ, Spiess BD, McCarthy RJ, Ivankovich AD. Effects of Progressive Blood Loss on Coagulation as Measured by Thrombelastography. Anesth Analg. 1987;66(9):856.
Ruttmann TG, Roche AM, Gasson J, James MFM. The effects of a one unit blood donation on auto-haemodilution and coagulation. Anaesth Intensive Care. 2003;31(1):40–3.

Details

Primary Language

English

Subjects

Anaesthesiology

Journal Section

Research Article

Authors

Alev Atalay ^*
0000-0003-3695-2866
Türkiye

Abdurrahim Derbent
0000-0002-0453-3897
Türkiye

Mustafa Nuri Deniz
0000-0002-6455-9132
Türkiye

Sezgin Ulukaya
0000-0001-7960-6192
Türkiye

Sacittin Taner Balcioğlu
0000-0003-1440-6661
Türkiye

Publication Date

June 10, 2025

Submission Date

January 29, 2025

Acceptance Date

April 7, 2025

Published in Issue

Year 2025 Volume: 64 Number: 2

DOI

https://doi.org/10.19161/etd.1627445

IZ

https://izlik.org/JA84EF93LC

Cite

RIS / Bibtex

Vancouver

1.Alev Atalay, Abdurrahim Derbent, Mustafa Nuri Deniz, Sezgin Ulukaya, Sacittin Taner Balcioğlu. Evaluation of perioperative coagulation in patients undergoing brain and spine surgery. EJM. 2025 Jun. 1;64(2):346-55. doi:10.19161/etd.1627445