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70. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Skandinavischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

12.05. - 15.05.2019, Würzburg

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Can platelet function testing with PFA100 reduce the risk of intracranial haemorrhage following deep brain stimulation surgery?

Kann die Rate von intrakraniellen Blutungen nach tiefer Hirnstimulation durch die präoperative Anwendung eines PFA100-Testes verringert werden?

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  • presenting/speaker Ann-Kristin Helmers - Universitätsklinikum Schleswig-Holstein, Campus Kiel, Klinik für Neurochirurgie, Kiel, Deutschland
  • Michael Synowitz - Universitätsklinikum Schleswig-Holstein, Campus Kiel, Klinik für Neurochirurgie, Kiel, Deutschland
  • Hubertus Maximilian Mehdorn - Universitätsklinikum Schleswig-Holstein, Campus Kiel, Klinik für Neurochirurgie, Kiel, Deutschland
  • Carolin Kubelt - Universitätsklinikum Schleswig-Holstein, Campus Kiel, Klinik für Neurochirurgie, Kiel, Deutschland
  • Steffen Paschen - Universitätsklinikum Schleswig-Holstein Campus Kiel, Klinik für Neurologie, Kiel, Deutschland
  • Daniela Falk - Universitätsklinikum Schleswig-Holstein, Campus Kiel, Klinik für Neurochirurgie, Kiel, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 70. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Skandinavischen Gesellschaft für Neurochirurgie. Würzburg, 12.-15.05.2019. Düsseldorf: German Medical Science GMS Publishing House; 2019. DocP105

doi: 10.3205/19dgnc441, urn:nbn:de:0183-19dgnc4411

Published: May 8, 2019

© 2019 Helmers et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

Text

Objective: The rate of intracranial haemorrhage (ICH) after deep brain stimulation ranges between 1.5 and 6.1% with permanent deficits detected in 0.4 to 2.53% of cases. Preventive steps must be introduced to avoid this serious complication. Therefore we assessed the use of preoperative platelet function screening.

Methods: We systematically reviewed the medical records of 485 consecutively admitted patients who underwent DBS surgery in a single-centre Universitätsklinikum setting between 2009 and 2018. The cohort was analysed for the onset of ICH. Since platelet function testing using the platelet function analyser (PFA)-100 was introduced in 2014, patients without preoperatively evaluated platelet function (n=359) were compared with 156 subjects in whom PFA-100 testing was performed prior to surgery. Patients with pathological platelet function were treated prophylactically with tranexamic acid.

Results: 14 out of 156 subjects screened with PFA-100 showed PFA-100 closure abnormalities: von-Willebrand disease (n=3) and 11 with no identifiable cause. Subjects with prolonged closure times were operated under administration of tranexamic acid. Of note, from the entire group bleeding without permanent deficits was seen in 11 patients not screened with PFA-100 (3.3%) and in two cases (1.3%) in the pretested group. ICH with permanent deficits occurred in five patients in the non-tested group (1.5%) compared to one patient in the screened cohort (0.6%) (p=0.24).

Conclusion: The incidence of ICH with permanent deficits tended to be lower in the patients undergoing DBS surgery with preoperative platelet function testing. Whether the administration of antifibrinolytic therapy may influence this outcome must be evaluated in a prospective study.