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  • Thromboelastography Utility: A retrospective case series of operative cranial hemorrhages

    Final Number:
    230

    Authors:
    Daniel Felbaum MD; Anthony G. Conte MD; Kyle Mueller MD; Hasan R Syed MD; Rocco Armonda MD

    Study Design:
    Other

    Subject Category:
    Intracranial Hemorrhage/Critical Care

    Meeting: AANS/CNS Cerebrovascular Section 2015 Annual Meeting

    Introduction: Thromboelastography (TEG) has the potential of identifying patients with coagulopathies not detected on standard assays. Although commonly used in cardiothoracic surgery, TEG has not been widespread adopted into neurosurgical practice. The neurosurgical team in our institution has recently been using TEGs as an adjunct to help aid in identifying coagulopathies. We present our initial operative experience for all forms of cerebral hemorrhages in patients that had abnormal TEG.

    Methods: Clinical records gathered from June 2013 to September 2014 were retrospectively reviewed for all operative interventions performed by the senior author (RAA) involving patients with cerebral hemorrhages. Standard decompressive craniotomy or hemicraniectomy with hematoma evacuation was performed on all patients secondary to acute herniation syndromes. Standard coagulation tests were analyzed and compared to thromboelastography reports to identify other potential causes of the hemorrhage.

    Results: 36 patients with a mean age of 59 years old were identified as having cerebral hemorrhages over a 15-month period that underwent emergency surgical intervention. 16 patients had spontaneous supratentorial intracerebral hemorrhages and 20 patients developed a hemorrhage secondary to an identifiable trauma. For the spontaneous hemorrhages, the average volume of hematoma was 55ml. Patients were only operated upon developing an acute neurological decline with herniation syndrome. For the trauma patients, all patients underwent surgery with at least 1cm of hematoma size with 5mm of midline shift. Standard tests identified coagulopathies in 4 of 36 patients. Thromboelastography identified an additional 15 patients which prompted additional therapy or transfusion. TEGs were sensitive in exhibiting clotting dysfunction in patients that were on anti-platelet agents or patients unable to provide an accurate history.

    Conclusions: Thromboelastography is an underutilized technology that may be able to affect patient outcome by identifying coagulopathies for a certain population undetected by traditional testing. In particular, thromboelastography can aid in providing a quantitative analysis for platelet dysfunction.

    Patient Care: Aid in identifying coagulopathies

    Learning Objectives: By the conclusion of this session, participants should be able to become familiar with the potential utility of using thromboelastography to identify patients with platelet dysfunction or coagulopathy

    References:

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