title: Fibrinogen but not factor XIII deficiency is associated with bleeding after craniotomy.
abstract: BACKGROUND
  Postoperative haemorrhage in neurosurgery is associated with significant morbidity and mortality. There is controversy whether or not factor XIII (FXIII) deficiency leads to bleeding complications after craniotomy. Decreased fibrinogen levels have been associated with an increased incidence of bleeding complications in cardiac and orthopaedic surgery. The aim of this study was to assess perioperative fibrinogen and FXIII levels in patients undergoing elective intracranial surgery with and without severe bleeding events.
  
  
  METHODS
  Perioperative FXIII and fibrinogen levels were prospectively assessed in 290 patients undergoing elective craniotomy. Patients were divided into two groups according to the presence or absence of severe bleeding requiring surgical revision. Coagulation test results of these groups were compared using Student's t-test.
  
  
  RESULTS
  The incidence of postoperative severe bleeding was 2.4%. No differences in FXIII levels were observed, but postoperative fibrinogen levels were significantly lower in patients suffering from postoperative haematoma compared with those without postoperative intracranial bleeding complications [237 mg dl(-1) (standard deviation, SD 86) vs 170 mg dl(-1) (SD 35), P=0.03]. The odds ratio for postoperative haematoma in patients with a postoperative fibrinogen level below 200 mg dl(-1) was 10.02 (confidence interval: 1.19-84.40, P=0.03).
  
  
  CONCLUSIONS
  This study emphasizes the role of fibrinogen as potentially modifiable risk factor for perioperative bleeding in intracranial surgery. Future randomized controlled trials will be essential to identify patients who might benefit from fibrinogen substitution during neurosurgical procedures.
authors.affiliation: Department of Anesthesiology, General Intensive Care and Pain Control and.
authors.forename: D
authors.initials: D
authors.lastname: Adelmann
authors.affiliation: Department of Anesthesiology, General Intensive Care and Pain Control and.
authors.forename: D A
authors.initials: DA
authors.lastname: Klaus
authors.affiliation: Department of Anesthesiology and Intensive Care, Landes-Nervenklinik Wagner-Jauregg, Linz, Austria.
authors.forename: U M
authors.initials: UM
authors.lastname: Illievich
authors.affiliation: Department of Anesthesiology, General Intensive Care and Pain Control and.
authors.forename: C G
authors.initials: CG
authors.lastname: Krenn
authors.affiliation: Section for Medical Statistics, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.
authors.forename: C
authors.initials: C
authors.lastname: Krall
authors.affiliation: Department of Anaesthetics and Intensive Care, Evangelical Hospital Vienna, Vienna, Austria.
authors.forename: S
authors.initials: S
authors.lastname: Kozek-Langenecker
authors.affiliation: Department of Anesthesiology, General Intensive Care and Pain Control and eva.schaden@meduniwien.ac.at.
authors.forename: E
authors.initials: E
authors.lastname: Schaden
mesh_terms: D000293:Adolescent; D000328:Adult; D000347:Afibrinogenemia / Q000150:complications*; D000368:Aged; D000369:Aged, 80 and over; D001780:Blood Coagulation Tests; D020147:Coagulation Protein Disorders / Q000150:complications*; D016001:Confidence Intervals; D003399:Craniotomy / Q000009:adverse effects*; D005176:Factor XIII; D005260:Female; D005340:Fibrinogen / Q000032:analysis / Q000378:metabolism / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures; D016017:Odds Ratio; D010314:Partial Thromboplastin Time; D010976:Platelet Count; D019106:Postoperative Hemorrhage / Q000453:epidemiology* / Q000209:etiology*; D011446:Prospective Studies; D012372:ROC Curve; D055815:Young Adult
chemical_list: D005340:Fibrinogen; D005176:Factor XIII
keywords: blood coagulation disorders, surgery; blood coagulation tests; factor XIII; fibrinogen; haemorrhage; neurosurgery, complications