• World Neurosurg · Dec 2024

    Correlation between coagulation parameters and dense fibrin band configuration in tough intracerebral hematoma in anticoagulated patients.

    • Sadahiro Nomura, Hirokazu Sadahiro, Takao Inoue, Kazutaka Sugimoto, Natsumi Fujii, Kohei Haji, and Hideyuki Ishihara.
    • Department of Neurosurgery, Yamaguchi University School of Medicine, Ube, Yamaguchi, Japan. Electronic address: snomura@yamaguchi-u.ac.jp.
    • World Neurosurg. 2024 Dec 13: 123565123565.

    ObjectivePatients receiving anticoagulation therapy develop intracerebral hematomas, which are difficult to evacuate during endoscopic surgery. Insufficient thrombin activation results in the gradual conversion of fibrinogen to fibrin, forming dense fibrin bands (FBs) that harden the hematoma. We aimed to investigate the factors contributing to hematoma hardness.MethodsEleven men and 11 women (age range: 41-84 years) with hypertensive intracerebral hematomas underwent surgery between 2016 and 2018. Hematoma hardness was measured intraoperatively as the maximum breaking point under compression (Newton [N]) using a bar-type tester. Hematoma samples were graded based on histological FB density. The relationships between hardness, FB grade, and hematological parameters were assessed in patients with and without anticoagulation therapy.ResultsHematomas were categorized as non-hard (0-3.0 N, n = 16) or hard (3.0-7.0 N, n = 6). Hardness was strongly correlated with FB grade (r = 0.76) and prothrombin time-international normalized ratio (PT-INR) (r = 0.75) and moderately correlated with activated partial thromboplastin time (APTT) (r = 0.65). Three patients with hematoma receiving warfarin and one receiving factor Xa inhibitor demonstrated significantly higher FB grade (p = 0.008) and increased hematoma hardness (6.0 ± 1.4 N) compared with those without anticoagulation treatment (1.3 ± 1.2 N, p = 0.00001). Receiver operating characteristic curve analysis indicated that a PT-INR of 1.81 and an APTT of 32.3 s may predict hard hematomas.ConclusionTough hematomas were histologically characterized by high FB density. Preoperative PT-INR and APTT may predict the presence of tough hematomas.Copyright © 2024. Published by Elsevier Inc.

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