A46 Perioperative Factor XIII Levels in Patients undergoing Craniotomy

Abstract

Introduction: Coagulation factor XIII (FXIII) is essential for stabilization of the blood clot. Reduced FXIII levels have been determined in patients with otherwise unexplained intraoperative bleeding. 1,2 In neurosurgical patients, reduced FXIII levels have been associated with an increased risk of postoperative hematoma. 2 Methods: FXIII activity is routinely determined after induction of anesthesia and after skin closure in all patients undergoing craniotomy in the Wagner-Jauregg hospital in Linz, Austria. After ethics committee approval, anesthesia charts and discharge notes of all patients operated between September 2010 and March 2011 were reviewed for results of coagulation tests and incidence of postoperative hemorrhage. Results: We enrolled 165 patients (77 male (46.7%) and 88 female (53.3%); median age 53.8 years (25th and 75th percentile 43.0 and 63.7)). Seven patients were excluded due to missing FXIII values. Preoperative FXIII levels (mean, ± SD) were 82.0% ± 16.4% and decreased to 73.3% ± 16.8% postoperatively. Fifteen patients (9.1%) had preoperative FXIII levels of less than 60.0%, 32 patients (20.0%) had a postoperative FXIII level below 60%. Five patients (3%) had to undergo re-craniotomy for postoperative bleeding detected by CT scan. FXIII levels did not differ between patients with (preoperatively 81.8% ± 13.3%; postoperatively 69.8% ± 6.5%) and without (preoperative 82.0% ± 16.0%; postoperatively 73.4% ± 17.0%) postoperative bleeding. (t-test, P = 0.97, and P = 0.64, respectively). No bleeding complications were observed in patients with preoperative FXIII levels below 60.0%. Conclusion: No increased risk for bleeding complications after craniotomy in patients with decreased factor XIII levels is shown in this series. This finding could be explained by the overall coagulation management, which will be analyzed in a second step. References Gerlach R, Tolle F, Raabe A, Zimmermann M, Siegemund A, Seifert V. Increased risk for postoperative hemorrhage after intracranial surgery in patients with decreased factor XIII activity: implications of a prospective study. Stroke. 2002; 33(6): 1618-23. Wettstein P, Haeberli A, Stutz M, Rohner M, Corbetta C, Gabi K, et al. Decreased factor XIII availability for thrombin and early loss of clot firmness in patients with unexplained intraoperative bleeding. Anesth Analg. 2004; 99(5): 1564–9.