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

Kaynakça

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Ayrıntılar

Birincil Dil

İngilizce

Konular

Anesteziyoloji

Bölüm

Araştırma Makalesi

Yazarlar

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

Yayımlanma Tarihi

10 Haziran 2025

Gönderilme Tarihi

29 Ocak 2025

Kabul Tarihi

7 Nisan 2025

Yayımlandığı Sayı

Yıl 2025 Cilt: 64 Sayı: 2

DOI

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

IZ

https://izlik.org/JA84EF93LC

Kaynak Göster

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. ETD. 01 Haziran 2025;64(2):346-55. doi:10.19161/etd.1627445