[Diagnosis and treatment of disseminated intravascular coagulation associated with neurosurgical diseases; a proposal of a new scoring system for DIC].
The occurrence of disseminated intravascular coagulation (DIC) is not rare in neurosurgical patients. We investigated the therapeutic effects of gabexate mesilate (FOY) for DIC or DIC preparatory state in 70 cases. Underlying diseases were head injuries in 31 cases, intracranial hemorrhages in 19, subarachnoid hemorrhages in 10, cerebral infarctions or embolisms in 5, brain tumors in 3 and other diseases in 2. DIC or DIC preparatory states were induced by severe brain damage (26 cases), infection (26 cases), failure of other organs (6 cases), shock (5 cases), and others. On the basis of the clinical coagulation studies of these patients, we retrospectively established a new scoring system for DIC (neurosurgical DIC score) associated with neurosurgical diseases and evaluated whether it was useful. Because the original DIC score proposed by the Research Committee on Blood Coagulation Disorders supported by the Japanese Ministry of Health and Welfare was not correlated with the level of consciousness representing the primary brain damage, it was likely to be underestimated in neurosurgical patients. Therefore, we included the level of consciousness with a new DIC scoring system. The neurosurgical DIC score was calculated from platelet count (score 0-3), FDP (score 0-3) and the level of consciousness (score 0-2), and was diagnosed as DIC preparatory state if it was 3, calculated from 2 of the 3 parameters, and as DIC if it was over 4. The score should be checked twice if it was 3, especially after operation. The neurosurgical DIC score was significantly correlated with the original DIC score.(ABSTRACT TRUNCATED AT 250 WORDS)
Kameyama
S
S
Department of Neurosurgery, Brain Research Institute, Niigata University.
Fujii
Y
Y
Koike
T
T
Tanaka
R
R
Takahashi
H
H
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001927:Brain Diseases / Q000150:complications*; D001930:Brain Injuries / Q000150:complications; D002561:Cerebrovascular Disorders / Q000150:complications; D004211:Disseminated Intravascular Coagulation / Q000175:diagnosis* / Q000188:drug therapy; D005260:Female; D016670:Gabexate / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged
D016670:Gabexate