Common Coagulation Disorders That May Arise Intraoperatively: Specifically DIC

Abstract

Neurosurgical patients could have preexisting congenital or acquired systemic coagulation disorders that can complicate their intraoperative management. The most important coagulation disorder that may arise intraoperatively is disseminated intravascular coagulation (DIC). DIC is the result of a pathological overstimulation of the hemostatic pathway that could present as a simultaneous hemorrhagic and thrombotic process. Tissue factor (TF) plays an important role in the initiation of DIC in neurosurgical procedures. There is no single test or a set of tests that can accurately diagnose DIC. All laboratory testing should be combined with the clinical scenario to help with a diagnosis and management of DIC. DIC can occur intraoperatively during resection of brain tumors or with excessive use of hemostatic products like prothrombin complex concentrates (PCCs) and recombinant factor VIIa (rVIIa). The most important step in the management of DIC is to treat the underlying cause of DIC. The patient has to be supported aggressively with blood product replacement therapy and pharmacological agents depending on whether the patient has bleeding or thrombotic manifestations of DIC.