Screening for Platelet Dysfunction and Use of Prophylactic Tranexamic Acid in Patients Undergoing Deep Brain Stimulation: A Retrospective Analysis of Incidence and Outcome of Intracranial Hemorrhage
| Autor: | Carolin Kubelt, Michael Synowitz, Falk Birkenfeld, Steffen Paschen, Daniela Falk, Hubertus Maximilian Mehdorn, Karsten Witt, Günther Deuschl, Ulrike Nowak-Göttl, Ann-Kristin Helmers |
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| Rok vydání: | 2019 |
| Předmět: |
Adult
Male Deep brain stimulation Adolescent medicine.medical_treatment Deep Brain Stimulation Young Adult Preoperative Care medicine Von Willebrand disease Humans Mass Screening cardiovascular diseases Prospective Studies Prospective cohort study Aged Retrospective Studies medicine.diagnostic_test business.industry Incidence (epidemiology) Incidence Magnetic resonance imaging Retrospective cohort study Middle Aged medicine.disease Antifibrinolytic Agents nervous system diseases Treatment Outcome Tranexamic Acid Anesthesia Cohort Surgery Female Pre-Exposure Prophylaxis Neurology (clinical) Blood Platelet Disorders business Tomography X-Ray Computed Intracranial Hemorrhages Tranexamic acid medicine.drug |
| Zdroj: | Stereotactic and functional neurosurgery. 98(3) |
| ISSN: | 1423-0372 |
| Popis: | Introduction: The rate of intracranial hemorrhage (ICH) after deep brain stimulation (DBS) is between 1.5 and 6.1%, with prolonged deficits occurring in 0.4–2.5% of the patients. This retrospective study investigates whether the prophylactic administration of tranexamic acid (TA) to patients with abnormal platelet function detected preoperatively by platelet function analyzer (PFA) lowered the risk for an ICH event. Methods: We performed a systematic review of the medical records of 485 consecutively admitted patients who underwent bilateral DBS surgery in a single-center university hospital setting between 2009 and 2018. The cohort was split into two groups. In one group, preoperative PFA screening was performed (n = 156, patients recruited from 2014 to 2018), and TA was administered if platelet function was abnormal. No preoperative PFA was performed in the second group (n = 359, patients recruited from 2009 to 2013). Both cohorts were analyzed for the occurrence of ICH, defined by (i) detection of ICH in routine postoperative magnetic resonance/computed tomography imaging or (ii) in non-routine imaging for the onset of new neurological symptoms. Results: Fourteen of the 156 screened patients (9%) showed reproducible PFA-100 closure abnormalities (3 with von Willebrand disease, 11 with no identifiable cause of platelet dysfunction). Two of the 156 patients (1.3%) in this cohort revealed an ICH on imaging, 1 of whom (0.6%) exhibited a prolonged neurological deficit as a result of ICH. In the cohort without platelet testing, 11 of the 329 patients (3.3%) demonstrated ICH on imaging, of whom 5 (1.5%) suffered from a prolonged neurological deficit. Conclusion: In this retrospective study, the screening and the administration of TA appeared to lower the risk of an ICH by 1.8%. One patient with von Willebrand disease suffered an ICH despite TA treatment. A prospective study is needed to clarify the impact of platelet testing and TA administration on the of incidence ICH. |
| Databáze: | OpenAIRE |
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