[Pharmacologic treatment for 2 thrombocytopenic patients prior to neurosurgery]

Preoperative prophylaxis of hemorrhage for patients with thrombocytopenia or a platelet disorder is controversial. Platelet count correlates to a certain degree with risk of hemorrhage, and risk factors for hemorrhage should be assessed and treated before deciding on perioperative treatments. Thirteen percent of cirrhotic patients have a platelet count between 50,000 and 75,000/microL and thrombocytopenia is multifactorial in origin. Idiopathic thrombocytopenic purpura is an acquired disease; since it may be either primary or secondary to other conditions, treatment may vary considerably. No clinical method has been established for predicting risk of perioperative bleeding in patients with thrombocytopenia. We describe 2 thrombocytopenic patients scheduled for intracranial surgery who were treated with thrombopoietic growth factors; in both cases, platelet counts increased sufficiently for this type of surgery. Controlled clinical trials are needed to ascertain the safety and prophylactic utility of platelet transfusion and thrombopoietin analogs in certain situations of refractory thrombocytopenia.