Abstract
Coagulation disorders can have a major impact on the outcome of neurosurgical patients.
The central nervous system is located within the closed space of the skull, and therefore,
intracranial hemorrhage can lead to intracranial hypertension. Acute brain injury
has been associated with alterations of various hemostatic parameters. Point-of-care
(POC) techniques such as rotational thromboelastometry are able to identify markers
of coagulopathy which are not reflected by standard assessment of hemostasis (e.g.,
hyperfibrinolysis). In patients with acute brain injury, POC test results have been
associated with important outcome parameters such as mortality and need for neurosurgical
intervention. POC devices have also been used to rapidly identify and quantify the
effects of antithrombotic medication. In cases of life-threatening intracranial hemorrhage,
this information can be valuable when deciding over administration of prohemostatic
substances or immediate neurosurgical intervention. In elective neurosurgical procedures,
POC devices can provide important information when unexpected bleeding occurs or in
cases of prolonged operative time with subsequent blood loss. Initial experiences
with POC devices in neurosurgical care have shown promising results but further studies
are needed to characterize their full potential and limitations.
Keywords
intracranial hemorrhage - coagulation - antithrombotic medication - craniotomy - bedside
testing
