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Update on hemostasis: neurosurgery
1Duke University Medical Center, Durham, NC 27710, USA. gerald.grant@duke.edu
Surgery
|November 21, 2007
Summary
Maintaining hemostasis during neurosurgery is vital. This review covers disseminated intravascular coagulation (DIC) and adjuncts like fibrin sealants and recombinant factor VIIa (rFVIIa) for controlling bleeding.
Area of Science:
- Neurosurgery
- Hematology
- Trauma Medicine
Background:
- Maintaining hemostasis is critical for neurosurgical outcomes.
- Brain trauma can trigger a cascade leading to disseminated intravascular coagulation (DIC).
- Exaggerated fibrinolytic responses complicate hemostasis in neurosurgery.
Purpose of the Study:
- To review intraoperative adjuncts for controlling bleeding in neurosurgery.
- To discuss disseminated intravascular coagulation (DIC) in the context of neurotrauma.
- To cover the use and mechanism of recombinant factor VIIa (rFVIIa) in neurosurgical bleeding.
Main Methods:
- Literature review of intraoperative hemostatic adjuncts.
- Discussion of the pathophysiology of DIC following brain trauma.
- Review of studies on recombinant factor VIIa (rFVIIa) in neurosurgery.
Main Results:
- Various adjuncts like gelatin sponge, thrombin, collagen, aprotinin, and fibrin sealants are effective for bleeding control.
- Recombinant factor VIIa (rFVIIa) offers a therapeutic option for neurosurgical bleeding.
- Ultra-early administration of rFVIIa shows potential in both military and civilian settings.
Conclusions:
- Effective hemostasis is paramount in neurosurgery.
- Understanding DIC and utilizing available adjuncts are key to managing bleeding.
- Recombinant factor VIIa (rFVIIa) represents an important advancement in controlling neurosurgical hemorrhage.
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