Evaluation of perioperative coagulation in patients undergoing brain and spine surgery

Aim: Conditions during brain and spine surgery, such as trauma, surgery, general anesthesia, fluid infusions, hypothermia, and patient inactivity, may lead to coagulation disorders, increasing the risk of bleeding or thrombosis. This study aimed to evaluate the relationship between thromboelastography (TEG), coagulation, and perioperative transfusion. Materials and Methods: In 2012, 58 adult ASA I–III patients undergoing brain and spine surgery were prospectively included after obtaining ethics committee approval and patient consent. Patients with coagulopathy or anticoagulants were excluded. Fluid requirements were managed with balanced crystalloids, and selected patients were randomly administered 6% hydroxyethyl starch or 4% gelatin solutions. Coagulation was monitored preoperatively, at the end of surgery, and 24 hours postoperatively using TEG and standard coagulation parameters. Results: The mean age of the patients was 46.7 years, the mean BMI was 27.7, and 62.1% were female. Eleven patients (18.9%) required an average of 6.1 (±4.1) mL/kg erythrocyte transfusion. Transfused patients had longer operative times (p=0.022), anesthesia durations (p=0.014), total fluid requirements (p<0.001), and crystalloid infusions (p=0.039). TEG data revealed no coagulation abnormalities causing clinical bleeding. However, postoperative Maximum Amplitude (MA) significantly increased in both groups. MA showed a positive correlation with age (r=0.27, p=0.039) and crystalloid volume (r=0.29, p=0.027), and a negative correlation with the lowest temperature (r=-0.28, p=0.029). Coagulation Index (CI) was positively correlated with preoperative fibrinogen levels (r=0.28, p=0.045). Conclusion: TEG analysis showed similar coagulation profiles in transfused and non-transfused patients. Before drawing general conclusions about perioperative coagulation, these findings should be compared with studies using restrictive transfusion protocols.