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November 1, 2012Neurosurgical FOCUSOpen Access

On the value of routine prothrombin time screening in elective neurosurgical procedures

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Key result

Preoperatively elevated prothrombin time was not significantly associated with the occurrence of hemorrhagic complications requiring repeat surgery in patients undergoing elective neurosurgical procedures (p = 0.12).

Why the study?

Does routine preoperative prothrombin time screening predict hemorrhagic complications in patients undergoing elective neurosurgical procedures?

Population

4,310 patients admitted to general wards for routinely planned neurosurgical surgery between 2006 and 2010.

Design

Cohort

Follow-up

perioperative

Authors

SDStephan DützmannFGFlorian GeßlerGMGerhard Marquardt

Discussion

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Overview

Preoperative PT elevation does not predict reoperation for bleeding; leaves open whether selective testing improves risk stratification in elective neurosurgery.

Study Design

Type

Observational (n=4,310)

Multicenter

No

Structured PICO

Does routine preoperative prothrombin time screening predict hemorrhagic complications in patients undergoing elective neurosurgical procedures?

P
Population
4,310 patients admitted for routinely planned elective neurosurgical procedures, excluding trauma and ICU patients, evaluated for the association between preoperative prothrombin time and hemorrhagic complications.
E
Exposure
Routine preoperative assessment of prothrombin time (PT)
O
Outcome
Hemorrhagic complications requiring repeat surgery and their association with preoperatively elevated PT levelssafety

Main Result

Absolute Event Rate: 2.6% vs 0.73%

p-value: p=0.12

Routine preoperative prothrombin time testing has limited value in elective neurosurgical patients with a normal history, as unexpected PT elevations are rare and not significantly associated with hemorrhagic complications.

Limitations

  • Retrospective design
  • Coagulation factors were substituted in most patients with elevated PTs, potentially masking the true bleeding risk
  • Very small number of patients (n=5) with unexpectedly elevated PTs

Cite This Study

Dützmann et al. (2012) conducted an observational in Elective neurosurgical procedures (n=4,310). Preoperatively elevated prothrombin time (INR > 1.28) vs. Normal preoperative prothrombin time was evaluated on Hemorrhagic complications requiring repeat surgery (p=0.12). Preoperatively elevated prothrombin time was not significantly associated with the occurrence of hemorrhagic complications requiring repeat surgery in patients undergoing elective neurosurgical procedures (p = 0.12).

synapsesocial.com/papers/6a706fece5469ee92be12bafhttps://doi.org/10.3171/2012.7.focus12219
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Also Consider

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  1. 1Coagulation Studies in Preoperative Neurosurgical Patients2001 · 42 citations
  2. 2Prothrombin complex concentrate (Beriplex® P/N) for emergency anticoagulation reversal: a prospective multinational clinical trial2008 · 315 citations
  3. 3Major bleeding during anticoagulation after cerebral ischemia1999 · 312 citations
  4. 4The Dilemma of Discontinuation of Anticoagulation Therapy for Patients with Intracranial Hemorrhage and Mechanical Heart Valves1998 · 163 citations
  5. 5Invasive line placement in critically ill patients: do hemostatic defects matter?1996 · 61 citations