Review article

TREATMENT OF COAGULATION DISORDERS IN NEUROSURGICAL PATIENTS

DINKO TONKOVIĆ ; University of Zagreb, School of Medicine, Department of Anesthesiology, Resuscitation and Intensive Care, Zagreb University Hospital Centre, Zagreb, Croatia

Abstract

Coagulation disorders in neurosurgery have many causes depending on intracranial pathology. Progress in treatment is possible with close collaboration of neurosurgeon and anesthesiologists and the application of modern principles of diagnosis and treatment. Urgent neurosurgical interventions are especially demanding when treatment is directed to formation of a stable clot and stopping bleeding to avoid secondary brain injury. Diagnosis and treatment is based on the application of point of care coagulation tests using thromboelastography and platelet aggregation tests that more precisely and faster than standard tests show pathological changes in coagulation. In elective surgery, it is necessary to ensure optimum coagulation status prior to surgery. If patient history shows a tendency to bleed or taking anticoagulant and antiaggregation drugs, detailed evaluation of the coagulation status and optimization of the condition of the patient is required, with possible consultation with hematologist. Anticoagulant and anti-platelet drugs should be discontinued and converted to low molecular weight heparin with timely repeal prior to surgical procedure. Postoperative prophylaxis of deep vein thrombosis includes mechanical forms of prevention and application of low molecular weight heparin, which, if timely and individually adjusted, has greater benefi t for the patient compared with the risk of bleeding.

Keywords

coagulation disorder; neurosurgical procedure; point of care tests

Hrčak ID:

237922

URI

https://hrcak.srce.hr/237922

Publication date:

24.4.2020.

Article data in other languages: croatian

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