Skip to main content
PMC home page
Journal of Neurology, Neurosurgery, and Psychiatry logoLink to Journal of Neurology, Neurosurgery, and Psychiatry
. 1997 Sep;63(3):334–338. doi: 10.1136/jnnp.63.3.334

Haemostatic changes during surgery for primary brain tumours

K Y Goh 1, W Tsoi 1, C Feng 1, N Wickham 1, W S Poon 1
PMCID: PMC2169692  PMID: 9328250

Abstract

OBJECTIVE—Primary brain tumours may be associated with coagulation disorders which can pose intraoperative and postoperative management difficulties. The aim was to evaluate the coagulation profile of patients with brain tumours undergoing surgery using thromboelastography (TEG) in combination with simple laboratory tests.
METHODS—Fifty adult patients with primary brain tumours larger than 4 cm in maximum diameter and no history of coagulation disorders were studied in a prospective, observational manner over a one year period. Preoperative, intraoperative, and postoperative measurements included haemoglobin concentration, platelet count, prothrombin and partial thromboplastin times, fibrin(ogen) degradation product concentration, D-dimer concentration, and TEG.
RESULTS—Eleven patients (22%) had abnormal intraoperative TEGs, of whom six (12%) subsequently developed haematomas requiring surgical evacuation. The coagulopathy seemed to be hyperfibrinolysis in two cases (4%) and disseminated intravascular coagulation in four (8%). There was no preoperative difference in reaction time (R time) for clot formation between the non-haematoma and haematoma groups(mean 11.44 (SD 3.42) v 12.33 (2.50) min, P= 0.46). However, when other preoperative indices were compared, in the non-haematoma group, K time (time to reach a clot amplitude of 20 mm) was shorter (6.72 (2.15) v 10.56 (3.50) min, P=0.001), rate of clot growth (å) was faster (43.67°(7.53) v 27.11° (5.42) , P<0.0001) and maximum amplitude of clot strength (MA) was greater (52.64 (7.85) v 40.33(6.59) mm, P< 0.001). Intraoperatively, R time was significantly shortened in the non-haematoma group, (7.67 (1.78) min, P<0.0001) unlike the haematoma group (10.67 (1.58) minutes, P=0.11).
CONCLUSIONS—Although these results indicate a general hypercoagulability during brain tumour surgery, in certain cases, a predisposition towards hypocoagulability may exist even before surgery, detectable only when the physical characteristics of clot formation are studied by TEG. Judicious replacement of clotting factors, platelets, and antifibrinolytic agents should be considered intraoperatively if the TEG is abnormal, without waiting for laboratory test results.



Full Text

The Full Text of this article is available as a PDF (123.4 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Fujii Y., Tanaka R., Takeuchi S., Koike T., Minakawa T., Sasaki O. Serial changes in hemostasis after intracranial surgery. Neurosurgery. 1994 Jul;35(1):26–33. doi: 10.1227/00006123-199407000-00004. [DOI] [PubMed] [Google Scholar]
  2. Howland W. S., Castro E. B., Fortner J. B., Gould P. Proceedings: Hypercoagulability. Thrombelastographic monitoring during extensive hepatic surgery. Arch Surg. 1974 Apr;108(4):605–608. doi: 10.1001/archsurg.1974.01350280205034. [DOI] [PubMed] [Google Scholar]
  3. Howland W. S., Schweizer O., Gould P. A comparison of intraoperative measurements of coagulation. Anesth Analg. 1974 Sep-Oct;53(5):657–663. [PubMed] [Google Scholar]
  4. Huang C. Y., Yu Y. L., Woo K. W., Chan F. L. Cerebral haemorrhage in a urban Chinese population. Funct Neurol. 1986 Jul-Sep;1(3):213–221. [PubMed] [Google Scholar]
  5. Iberti T. J., Miller M., Abalos A., Fischer E. P., Post K. D., Benjamin E., Oropello J. M., Wiltshire-Clement M., Rand J. H. Abnormal coagulation profile in brain tumor patients during surgery. Neurosurgery. 1994 Mar;34(3):389–395. doi: 10.1227/00006123-199403000-00001. [DOI] [PubMed] [Google Scholar]
  6. Jones N. R., Blumbergs P. C. Intracranial haemorrhage from meningiomas: a report of five cases. Br J Neurosurg. 1989;3(6):691–698. doi: 10.3109/02688698908992693. [DOI] [PubMed] [Google Scholar]
  7. Kaufman H. H., Moake J. L., Olson J. D., Miner M. E., duCret R. P., Pruessner J. L., Gildenberg P. L. Delayed and recurrent intracranial hematomas related to disseminated intravascular clotting and fibrinolysis in head injury. Neurosurgery. 1980 Nov;7(5):445–449. doi: 10.1227/00006123-198011000-00003. [DOI] [PubMed] [Google Scholar]
  8. MacGee E. E., Bernell W. R. Acute fibrinolysis following craniotomy and removal of metastatic tumor of the cerebellum. Case report. J Neurosurg. 1970 May;32(5):578–580. doi: 10.3171/jns.1970.32.5.0578. [DOI] [PubMed] [Google Scholar]
  9. Mattock C., Crockard A. Does intravascular coagulation contribute to the operative mortality for large acoustic neuromas? J Neurol Neurosurg Psychiatry. 1986 Jun;49(6):699–701. doi: 10.1136/jnnp.49.6.699. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Morozov V. V. Svertyvaiushchaia i protivosvertyvaiushchaia sistema krovi pri opukholiakh golovnogo mozga supratentrial'noi lokalizatsii. Zh Nevropatol Psikhiatr Im S S Korsakova. 1968;68(4):505–509. [PubMed] [Google Scholar]
  11. Oka K., Tsuda H., Kamikaseda K., Nakamura R., Fukui M., Nouzuka Y., Sueishi K. Meningiomas and hemorrhagic diathesis. J Neurosurg. 1988 Sep;69(3):356–360. doi: 10.3171/jns.1988.69.3.0356. [DOI] [PubMed] [Google Scholar]
  12. Olson J. D., Kaufman H. H., Moake J., O'Gorman T. W., Hoots K., Wagner K., Brown C. K., Gildenberg P. L. The incidence and significance of hemostatic abnormalities in patients with head injuries. Neurosurgery. 1989 Jun;24(6):825–832. doi: 10.1227/00006123-198906000-00007. [DOI] [PubMed] [Google Scholar]
  13. Palmer J. D., Francis D. A., Roath O. S., Francis J. L., Iannotti F. Hyperfibrinolysis during intracranial surgery: effect of high dose aprotinin. J Neurol Neurosurg Psychiatry. 1995 Jan;58(1):104–106. doi: 10.1136/jnnp.58.1.104. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Palmer J. D., Sparrow O. C., Iannotti F. Postoperative hematoma: a 5-year survey and identification of avoidable risk factors. Neurosurgery. 1994 Dec;35(6):1061–1065. doi: 10.1227/00006123-199412000-00007. [DOI] [PubMed] [Google Scholar]
  15. Prasad K. S., Sharma B. S., Marwaha N., Sarode R. S., Kak V. K. Haemostatic derangement in patients with intracranial tumours. Br J Neurosurg. 1994;8(6):695–702. doi: 10.3109/02688699409101183. [DOI] [PubMed] [Google Scholar]
  16. Saleem A., Blifeld C., Saleh S. A., Yawn D. H., Mace M. L., Schwartz M., Crawford E. S. Viscoelastic measurement of clot formation: a new test of platelet function. Ann Clin Lab Sci. 1983 Mar-Apr;13(2):115–124. [PubMed] [Google Scholar]
  17. Sawaya R., Donlon J. A. Chronic disseminated intravascular coagulation and metastatic brain tumor: a case report and review of the literature. Neurosurgery. 1983 May;12(5):580–584. doi: 10.1227/00006123-198305000-00020. [DOI] [PubMed] [Google Scholar]
  18. Sawaya R., Glas-Greenwalt P. Postoperative venous thromboembolism and brain tumors: Part II. Hemostatic profile. J Neurooncol. 1992 Oct;14(2):127–134. doi: 10.1007/BF00177616. [DOI] [PubMed] [Google Scholar]
  19. Shi F. L., Hart R. G., Sherman D. G., Tegeler C. H. Stroke in the People's Republic of China. Stroke. 1989 Nov;20(11):1581–1585. doi: 10.1161/01.str.20.11.1581. [DOI] [PubMed] [Google Scholar]
  20. Singh V. P., Jain D., Mohan R., Bhatia R., Bhargava M. Haemostatic abnormalities in brain tumours. Acta Neurochir (Wien) 1990;102(3-4):103–107. doi: 10.1007/BF01405422. [DOI] [PubMed] [Google Scholar]
  21. Spiess B. D., Tuman K. J., McCarthy R. J., DeLaria G. A., Schillo R., Ivankovich A. D. Thromboelastography as an indicator of post-cardiopulmonary bypass coagulopathies. J Clin Monit. 1987 Jan;3(1):25–30. doi: 10.1007/BF00770880. [DOI] [PubMed] [Google Scholar]
  22. Tsuda H., Oka K., Noutsuka Y., Sueishi K. Tissue-type plasminogen activator in patients with intracranial meningiomas. Thromb Haemost. 1988 Dec 22;60(3):508–513. [PubMed] [Google Scholar]
  23. van der Sande J. J., Veltkamp J. J., Bouwhuis-Hoogerwerf M. L. Hemostasis and intracranial surgery. J Neurosurg. 1983 May;58(5):693–698. doi: 10.3171/jns.1983.58.5.0693. [DOI] [PubMed] [Google Scholar]

Articles from Journal of Neurology, Neurosurgery, and Psychiatry are provided here courtesy of BMJ Publishing Group

RESOURCES