The effects of different surgical modes on coagulation and fibrinolysis system in patients with aneurysmal subarachnoid hemorrhage.

Abstract

Objective: To explore the effects of different surgical methods on the coagulation and fibrinolysis systems of patients with aneurysmal subarachnoid hemorrhage (aSAH).

Methods: A retrospective case-control study was employed, in 276 patients with aSAH. Patients were non-randomly assigned according to treatment methods: craniotomy clipping surgery, coil embolization and stent assisted coil surgery. Glasgow Coma Scale (GCS) was used to assess neurological function at discharge, and Modified Rankin Scale (mRS) was applied to evaluate neurological function prognosis at 12 months postoperatively. Spearman correlation analysis was used to investigate the correlation. Holm Bonferroni method was used to correct for multiple comparisons.

Results: longer PT and APTT with higher D-dimer levels were observed in the stent assisted coil embolization group than the craniotomy clipping group and coil embolization group (p < 0.05). The FIB level in the craniotomy clipping group was significantly lower than that in the stent assisted coil embolization group and the coil embolization group (p < 0.05). Correlation analysis showed that postoperative PT, TT, APTT, INR, D-D levels were negatively correlated with GCS scores, but positively correlated with mRS scores (p < 0.05); FIB and PLT levels were positively correlated with GCS scores, but negatively correlated with mRS scores (p < 0.05).

Conclusion: The postoperative PT, APTT prolongation and D-dimer elevation were most significant in the craniotomy clipping group. Perioperative coagulation function monitoring has clinical value for aSAH patients. The above differences may be related to the degree of surgical trauma, antithrombotic treatment regimen, and the combined effect of inflammatory response. Their specific mechanisms need further research.