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Disseminated intravascular coagulation after craniotomy.

Jeffrey J Pasternak1, Dana N Hertzfeldt, Sharm R Stanger

  • 1Department of Anesthesiology, College of Medicine and School of Health Related Sciences, Mayo Clinic, Rochester, MN 55905, USA. pasternak.jeffrey@mayo.edu

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Disseminated intravascular coagulation (DIC) is rare after craniotomy, occurring in 13-44 per 10,000 patients. Traumatic head injury significantly increases DIC risk, which carries a high mortality rate.

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Area of Science:

  • Neurosurgery
  • Hematology

Background:

  • Disseminated intravascular coagulation (DIC) is a known complication in neurosurgical patients.
  • The incidence of DIC following craniotomy procedures remains largely unquantified.

Purpose of the Study:

  • To determine the incidence of DIC after primary craniotomy.
  • To identify risk factors associated with DIC development post-craniotomy.
  • To assess the mortality associated with DIC in this patient population.

Main Methods:

  • Retrospective analysis of 3164 patients undergoing primary craniotomy between 2000-2004.
  • Case identification using hospital discharge summaries, blood product administration, and laboratory assessments (fibrinogen, d-dimer).
  • Statistical analysis to determine incidence, risk factors (traumatic head injury, salvaged blood), and mortality rates.

Main Results:

  • An estimated incidence of DIC within 72 hours of craniotomy ranged from 13 to 44 per 10,000 patients.
  • Mortality rates for DIC post-craniotomy were high, ranging from 43% to 75%.
  • Traumatic head injury was a significant risk factor (OR 16-29); salvaged blood use suggested increased risk (OR 24).

Conclusions:

  • DIC is a rare but serious complication following craniotomy.
  • Prompt recognition and management are crucial due to high associated mortality.
  • Further research is needed to clarify the role of salvaged blood in DIC development.