title: Association of perioperative factor XIII activity levels and other haemostatic markers with the risk of postoperative intracranial haematoma in a selected cohort of neurosurgical patients.
abstract: BACKGROUND
  Coagulation factor XIII and other haemostatic markers are known strengthen fibrin clot formation and, hence, may facilitate safer surgery. Currently however, factor XIII activity levels are not routinely screen. Therefore, the purpose of this study was to determine the association of perioperative factor XIII activity levels and other haemostatic markers with postoperative intracranial haematoma formation in neurosurgical patients.
  
  
  METHODS
  Between January 2008 to Jun 2009, all neurosurgical patients who underwent intracranial surgery were screened for the study. Patients had blood samples taken preoperatively and within 24 h post-surgery for factor XIII and other haemostatic markers. The intracranial surgeries for the patients involved were performed according to their respective indications using standard neurosurgical techniques. Postoperatively, patients had a computed tomography (CT) brain scan, with the imaging results grouped into three classes: significant haematoma (group I), insignificant haematoma (group II) and no haematoma (group III).
  
  
  RESULTS
  Of the total 84 enrolled patients, 5 (6%), 28 (33.3%) and 51 (60.7%) patients were assigned to group I, II and III respectively. Significant postoperative haematoma that required re-surgery was related to low postoperative platelet count (p < 0.01), and higher odds ratio of developing postoperative intracranial haematoma were shown with two combination factors: low postoperative factor XIII and platelet levels; and low postoperative factor XIII and antithrombin levels.
  
  
  CONCLUSIONS
  Low platelet count can cause significant volume postoperative intracranial haematoma and in presence of multiple defects in haemostatic markers appears to be clinically useful to predict the formation of postoperative intracranial haematoma in neurosurgical patients.
authors.affiliation: Department of Neurosciences, School of Medical Sciences, Hospital Universiti Sains Malaysia, Kelantan, Malaysia. zamzuri@kb.usm.my
authors.forename: Zamzuri
authors.initials: Z
authors.lastname: Idris
authors.forename: Mustapha
authors.initials: M
authors.lastname: Muzaimi
authors.forename: Suryati
authors.initials: S
authors.lastname: Hussin
authors.forename: Wan Haslindawani Wan
authors.initials: WH
authors.lastname: Mahmood
authors.forename: Wan Zaidah
authors.initials: WZ
authors.lastname: Abdullah
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D001932:Brain Neoplasms / Q000601:surgery; D015331:Cohort Studies; D005176:Factor XIII / Q000032:analysis / Q000378:metabolism*; D005260:Female; D006406:Hematoma / Q000097:blood*; D006801:Humans; D020300:Intracranial Hemorrhages / Q000097:blood*; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D011183:Postoperative Complications / Q000097:blood*; D018570:Risk Assessment; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D015415:Biomarkers; D005176:Factor XIII