title: Disseminated intravascular coagulation after craniotomy.
abstract: Disseminated intravascular coagulation (DIC) is reported in neurosurgical patients; however, the incidence of DIC after craniotomy procedures is unknown. Using a surgical database, we identified 3164 patients who underwent primary craniotomy at Mayo Clinic Rochester between January 1, 2000 and December 31, 2004. Potential cases of DIC in this population were identified using 3 search triggers, patients: (1) in whom the diagnosis of DIC was noted on their hospital discharge summary, (2) who received red blood cell-free blood products, or (3) in whom a blood fibrinogen or d-dimer concentration was assessed. Using criteria based on laboratory values, we estimated the incidence of DIC developing within 72 hours of primary craniotomy to be between 13 and 44 per 10,000 patients. Despite a low incidence of DIC, the associated mortality rate was 43% to 75%. Traumatic head injury was a significant risk factor for the development of DIC [odds ratio of trauma was in the range of 16 (95% confidence interval (CI)=5.3-49) to 29 (CI=4.0-204)]. Autologous salvaged blood was administered intraoperatively to 44 patients, and 1 of these developed DIC. Although this small sample of patients receiving salvaged blood requires caution in interpreting the results, the risk of DIC seemed to be greater with salvaged blood than without [odds ratio 24 (CI=2.5-237)]. In children, 2 of 3 patients who developed DIC had congenital malformations of the brain. Findings from this study suggest that DIC is rare after craniotomy, but is often associated with mortality.
authors.affiliation: Department of Anesthesiology, College of Medicine and School of Health Related Sciences, Mayo Clinic, Rochester, MN 55905, USA. pasternak.jeffrey@mayo.edu
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Pasternak
authors.forename: Dana N
authors.initials: DN
authors.lastname: Hertzfeldt
authors.forename: Sharm R
authors.initials: SR
authors.lastname: Stanger
authors.forename: Kirsten R
authors.initials: KR
authors.lastname: Walter
authors.forename: Travis D
authors.initials: TD
authors.lastname: Werts
authors.forename: Mary E S
authors.initials: ME
authors.lastname: Marienau
authors.forename: William L
authors.initials: WL
authors.lastname: Lanier
mesh_terms: D000328:Adult; D000368:Aged; D001688:Biological Products; D001804:Blood Transfusion, Autologous; D001930:Brain Injuries / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D003399:Craniotomy; D004211:Disseminated Intravascular Coagulation / Q000453:epidemiology* / Q000209:etiology* / Q000401:mortality; D005260:Female; D005340:Fibrinogen / Q000378:metabolism; D006801:Humans; D007231:Infant, Newborn; D002538:Intracranial Arteriovenous Malformations / Q000150:complications; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures; D010976:Platelet Count; D011183:Postoperative Complications / Q000453:epidemiology* / Q000401:mortality; D011517:Prothrombin Time; D012307:Risk Factors
chemical_list: D001688:Biological Products; D005340:Fibrinogen