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Author Spotlight: Deciphering Coagulation Disorders in Traumatic Brain Injury Patients
Published on: August 4, 2023
The relationship between serum coagulation parameters and the recurrence of chronic subdural hematoma
1Department of Neurosurgery, The Fourth affiliated Hospital of Soochow University, Suzhou, 215123, Jiangsu, China.
Insights
Elevated fibrin/fibrinogen degradation products (FDP) and D-dimer (D-D) levels before hospitalization predict chronic subdural hematoma (CSDH) recurrence, especially within 30 days post-surgery. Close monitoring is advised for older CSDH patients.
Area of Science:
- Neurology
- Hematology
- Medical Diagnostics
Background:
- Chronic subdural hematoma (CSH) is a common neurosurgical condition.
- Recurrence of CSH poses significant challenges in patient management.
- Predictive markers for CSH recurrence are crucial for optimizing treatment strategies.
Purpose of the Study:
- To investigate the association between pre-hospitalization serum coagulation parameters and CSH recurrence.
- To identify novel predictors for CSH recurrence, particularly early post-operative relapse.
- To evaluate the combined predictive value of D-dimer (D-D) and fibrin/fibrinogen degradation products (FDP).
Main Methods:
- Retrospective analysis of 236 first-time CSH patients with complete medical records.
- Follow-up for at least 90 days to assess recurrence rates.
- Univariate analysis of general, imaging, and laboratory data, including PT, APTT, D-D, and FDP levels.
Main Results:
- CSH recurrence was observed in 21.2% of patients.
- Significant recurrence predictors included advanced age, hypertension, liver disease, anticoagulant/antiplatelet use, bilateral, and single-layer hematomas.
- Elevated FDP (>5 mg/L) and combined elevated D-D and FDP levels were significantly associated with CSH recurrence, especially within 30 days post-surgery.
Conclusions:
- Serum FDP and D-D levels upon admission are potential novel predictors for CSH recurrence.
- Simultaneous elevation of FDP and D-D may indicate a higher risk of early post-operative recurrence.
- Older CSH patients undergoing surgery require close monitoring due to higher recurrence rates.
Abstract:
The aim is to investigate the relationship between serum coagulation parameters (PT, APTT, D-D and FDP) before hospitalization and recurrence of chronic subdural hematoma (CSDH). 236 patients with CSDH who were diagnosed for the first time and had complete medical records were followed up for at least 90 days. Fifty patients (21.2%) had relapsed. Univariate analysis was conducted including general data, imaging data and test results. Serum coagulation parameters (PT, APTT, D-D and FDP) were detected for all CSDH patients. The study identified several factors that exhibited a significant correlation with chronic subdural hematoma (CSDH) recurrence. These factors included advanced age (p = 0.01), hypertension (p = 0.04), liver disease (p = 0.01), anticoagulant drug use (p = 0.01), antiplatelet drug use (p = 0.02), bilateral hematoma (p = 0.02), and single-layer hematoma (p = 0.01). In addition, the presence of fibrin/fibrinogen degradation products (FDP) exceeding 5 mg/L demonstrated a significant relationship with CSDH recurrence (P < 0.05). Notably, the combined assessment of D-dimer (D-D) and FDP exhibited a significant difference, particularly regarding recurrence within 30 days after surgery (P < 0.05). The simultaneous elevation of serum FDP and D-D levels upon admission represents a potentially novel predictor for CSDH recurrence. This finding is particularly relevant for patients who experience recurrence within 30 days following surgical intervention. Older individuals with CSDH who undergo trepanation and drainage should be closely monitored due to their relatively higher recurrence rate.
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