Portal de Periódicos da CAPES

Role of Perioperative Factor XIII in Intracerebral Hemorrhage after Brain Tumor Surgery: A Prospective Study

2019; RELX Group (Netherlands); Linguagem: Inglês

10.2139/ssrn.3398543

1556-5068

Estela Val Jordán, Agustín Nebra Puertas, Juan Casado Pellejero, María Dolores Vicente Gordo, Concepción López, Nuria Fernández Monsteirín, Antonio Tejada Artigas, Manuel Quintana‐Díaz, Jesús Caballero,

Blood properties and coagulation

Background: Intracerebral hemorrhage (ICH) is one of the most feared complications after brain tumor surgery. Despite several factors are considered to influence bleeding, an increasing number of clinical studies emphasize that hemostatic disorders, developed during surgical aggression and tumoral status, could explain unexpected ICH. Blood clot stabilization depends on factor XIII (FXIII) levels. Postoperative hemorrhage has been described in presence of FXIII deficiency and normal standard coagulation tests in different surgical fields. However, there are no data about the incidence and relevance of ICH after brain tumor surgery. The objetive of this prospective study was to evaluate the influence of perioperative FXIII levels on ICH after brain tumor surgery.Methods: A prospective, observational, 18-month study was conducted at a single third-level hospital in Spain. The study included all consecutive adults operated on brain tumor and postoperatory stay in intensive care unit. Three blood samples evaluated FXIII levels (A-presurgical or baseline, B-postsurgical and C-24 hours after surgery). Normal range was 70-140%. ICH was defined as bleeding that generates radiological signs of intracranial hypertension either by volume or by mass effect on the routine CT scan 24 hours after surgery. Pearson Chi-squared test (X2) or Fisher's exact test were used in the inferential analysis for qualitative variables and Mann-Whitney U-test and T-Test for quantitative ones. P-value <0.05 was considered significant for confidence interval of 95%.Results: The study included 109 patients. ICH was confirmed in 39 of them (35,78%). The average of factor XIII in sample A was 77,52% in patients without ICH vs 71,2% in patients with ICH, in sample B 70,14% vs 51,57% and in sample C 69,68% vs 52,14%, respectively. Inferential analysis determined significant association between factor XIII-B and C deficiency with ICH (both p0,000) and absence of association in patients without ICH. Their variation, compared to the baseline sample, was also significative (factor XIII A-B p0,000 and factor XIII A-C p0,004). The relative risk of developing a postoperative hematoma is therefore increased 1,17-fold presurgery, 2,61-fold postsurgery and 4,63-fold 24hours after surgery in patients with FXIII <70%, respectively.Conclusion: FXIII deficiency after brain tumor surgery increased ICH. The risk is further increased in males and in those patients with low FXIII (<70%). Postoperative FXIII variation was also associated to ICH. Future studies would be necessary to demonstrate this association, in which case replacement treatment could become a therapeutic target.Funding Statement: The authors state: "No funding to declare."Declaration of Interests: The authors declare that they have no competing interests.Ethics Approval Statement: Written informed consent was required for all participants. Comité de Ética de Investigación de la Comunidad de Aragón (CEICA) approved the study (NºCP14/2013).