{"title":"Correlation between coagulation parameters and dense fibrin band configuration in tough intracerebral hematoma in anticoagulated patients.","authors":"Sadahiro Nomura, Hirokazu Sadahiro, Takao Inoue, Kazutaka Sugimoto, Natsumi Fujii, Kohei Haji, Hideyuki Ishihara","doi":"10.1016/j.wneu.2024.123565","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>Patients receiving anticoagulation therapy develop intracerebral hematomas, which are difficult to evacuate during endoscopic surgery. Insufficient thrombin activation results in the gradual conversion of fibrinogen to fibrin, forming dense fibrin bands (FBs) that harden the hematoma. We aimed to investigate the factors contributing to hematoma hardness.</p><p><strong>Methods: </strong>Eleven men and 11 women (age range: 41-84 years) with hypertensive intracerebral hematomas underwent surgery between 2016 and 2018. Hematoma hardness was measured intraoperatively as the maximum breaking point under compression (Newton [N]) using a bar-type tester. Hematoma samples were graded based on histological FB density. The relationships between hardness, FB grade, and hematological parameters were assessed in patients with and without anticoagulation therapy.</p><p><strong>Results: </strong>Hematomas were categorized as non-hard (0-3.0 N, n = 16) or hard (3.0-7.0 N, n = 6). Hardness was strongly correlated with FB grade (r = 0.76) and prothrombin time-international normalized ratio (PT-INR) (r = 0.75) and moderately correlated with activated partial thromboplastin time (APTT) (r = 0.65). Three patients with hematoma receiving warfarin and one receiving factor Xa inhibitor demonstrated significantly higher FB grade (p = 0.008) and increased hematoma hardness (6.0 ± 1.4 N) compared with those without anticoagulation treatment (1.3 ± 1.2 N, p = 0.00001). Receiver operating characteristic curve analysis indicated that a PT-INR of 1.81 and an APTT of 32.3 s may predict hard hematomas.</p><p><strong>Conclusion: </strong>Tough hematomas were histologically characterized by high FB density. Preoperative PT-INR and APTT may predict the presence of tough hematomas.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":"123565"},"PeriodicalIF":1.9000,"publicationDate":"2024-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"World neurosurgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.wneu.2024.123565","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Objective: Patients receiving anticoagulation therapy develop intracerebral hematomas, which are difficult to evacuate during endoscopic surgery. Insufficient thrombin activation results in the gradual conversion of fibrinogen to fibrin, forming dense fibrin bands (FBs) that harden the hematoma. We aimed to investigate the factors contributing to hematoma hardness.
Methods: Eleven men and 11 women (age range: 41-84 years) with hypertensive intracerebral hematomas underwent surgery between 2016 and 2018. Hematoma hardness was measured intraoperatively as the maximum breaking point under compression (Newton [N]) using a bar-type tester. Hematoma samples were graded based on histological FB density. The relationships between hardness, FB grade, and hematological parameters were assessed in patients with and without anticoagulation therapy.
Results: Hematomas were categorized as non-hard (0-3.0 N, n = 16) or hard (3.0-7.0 N, n = 6). Hardness was strongly correlated with FB grade (r = 0.76) and prothrombin time-international normalized ratio (PT-INR) (r = 0.75) and moderately correlated with activated partial thromboplastin time (APTT) (r = 0.65). Three patients with hematoma receiving warfarin and one receiving factor Xa inhibitor demonstrated significantly higher FB grade (p = 0.008) and increased hematoma hardness (6.0 ± 1.4 N) compared with those without anticoagulation treatment (1.3 ± 1.2 N, p = 0.00001). Receiver operating characteristic curve analysis indicated that a PT-INR of 1.81 and an APTT of 32.3 s may predict hard hematomas.
Conclusion: Tough hematomas were histologically characterized by high FB density. Preoperative PT-INR and APTT may predict the presence of tough hematomas.
期刊介绍：
World Neurosurgery has an open access mirror journal World Neurosurgery: X, sharing the same aims and scope, editorial team, submission system and rigorous peer review.
The journal''s mission is to:
-To provide a first-class international forum and a 2-way conduit for dialogue that is relevant to neurosurgeons and providers who care for neurosurgery patients. The categories of the exchanged information include clinical and basic science, as well as global information that provide social, political, educational, economic, cultural or societal insights and knowledge that are of significance and relevance to worldwide neurosurgery patient care.
-To act as a primary intellectual catalyst for the stimulation of creativity, the creation of new knowledge, and the enhancement of quality neurosurgical care worldwide.
-To provide a forum for communication that enriches the lives of all neurosurgeons and their colleagues; and, in so doing, enriches the lives of their patients.
Topics to be addressed in World Neurosurgery include: EDUCATION, ECONOMICS, RESEARCH, POLITICS, HISTORY, CULTURE, CLINICAL SCIENCE, LABORATORY SCIENCE, TECHNOLOGY, OPERATIVE TECHNIQUES, CLINICAL IMAGES, VIDEOS
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