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Postoperative Spinal Epidural Hematoma: The Danger Caused by the Misuse of Thrombin-Containing Local Hemostatics

STUDY DESIGN: Retrospective case-control study. PURPOSE: To examine the hypothesis that the misuse of thrombin-containing local hemostatics (TCLH) increases the risk of postoperative spinal epidural hematoma (POSEH). OVERVIEW OF LITERATURE: Many studies have focused on hypocoagulability as a risk fa...

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Autores principales: Ahn, Dong Ki, Shin, Won Shik, Kim, Go We, Koo, Ki Hyuk
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Korean Society of Spine Surgery 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5738310/
https://www.ncbi.nlm.nih.gov/pubmed/29279744
http://dx.doi.org/10.4184/asj.2017.11.6.898
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author Ahn, Dong Ki
Shin, Won Shik
Kim, Go We
Koo, Ki Hyuk
author_facet Ahn, Dong Ki
Shin, Won Shik
Kim, Go We
Koo, Ki Hyuk
author_sort Ahn, Dong Ki
collection PubMed
description STUDY DESIGN: Retrospective case-control study. PURPOSE: To examine the hypothesis that the misuse of thrombin-containing local hemostatics (TCLH) increases the risk of postoperative spinal epidural hematoma (POSEH). OVERVIEW OF LITERATURE: Many studies have focused on hypocoagulability as a risk factor for POSEH. However, there are no prior reports on the increased risk of POSEH in hypercoagulable states. METHODS: Posterior instrumented lumbar spine surgery cases over 2 consecutive years were divided into two groups: a study group (98 patients in whom TCLH was used) and a control group (176 patients in whom TCLH was not used). The excess TCLH matrix that was not associated with blood clot was not removed from the patients in the study group. The senior author decided whether to use TCLH or not. Suction drains were used in all patients. The demographics, coagulation-related factors, and intraoperative factors of the patients in the two groups were analyzed. The development of POSEH was compared between the two groups. RESULTS: The two groups were homogenous in demographics (age and sex), coagulation-related factors (platelet count, prothrombin time, activated partial thromboplastin time, and platelet function analysis), and surgical factors (total blood loss, operation time, blood loss/10 minutes, number of fusion segments, posterolateral fusion/posterior lumbar interbody fusion, and virgin or revision surgery). POSEH developed more frequently in the patients in the study group than in those in the control group (14/98 patients, 14.3% vs. 3/176 patients, 1.7%, respectively; p=0.001; odds ratio, 17.1). CONCLUSIONS: TCLH causes blood clot not only at the edge of damaged vessels but also at the site of extravascular blood. Excess TCLH matrix not associated with blood clot at the epidural space can enhance POSEH development because early clotted hematomas do not drain through suction drains.
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spelling pubmed-57383102017-12-26 Postoperative Spinal Epidural Hematoma: The Danger Caused by the Misuse of Thrombin-Containing Local Hemostatics Ahn, Dong Ki Shin, Won Shik Kim, Go We Koo, Ki Hyuk Asian Spine J Clinical Study STUDY DESIGN: Retrospective case-control study. PURPOSE: To examine the hypothesis that the misuse of thrombin-containing local hemostatics (TCLH) increases the risk of postoperative spinal epidural hematoma (POSEH). OVERVIEW OF LITERATURE: Many studies have focused on hypocoagulability as a risk factor for POSEH. However, there are no prior reports on the increased risk of POSEH in hypercoagulable states. METHODS: Posterior instrumented lumbar spine surgery cases over 2 consecutive years were divided into two groups: a study group (98 patients in whom TCLH was used) and a control group (176 patients in whom TCLH was not used). The excess TCLH matrix that was not associated with blood clot was not removed from the patients in the study group. The senior author decided whether to use TCLH or not. Suction drains were used in all patients. The demographics, coagulation-related factors, and intraoperative factors of the patients in the two groups were analyzed. The development of POSEH was compared between the two groups. RESULTS: The two groups were homogenous in demographics (age and sex), coagulation-related factors (platelet count, prothrombin time, activated partial thromboplastin time, and platelet function analysis), and surgical factors (total blood loss, operation time, blood loss/10 minutes, number of fusion segments, posterolateral fusion/posterior lumbar interbody fusion, and virgin or revision surgery). POSEH developed more frequently in the patients in the study group than in those in the control group (14/98 patients, 14.3% vs. 3/176 patients, 1.7%, respectively; p=0.001; odds ratio, 17.1). CONCLUSIONS: TCLH causes blood clot not only at the edge of damaged vessels but also at the site of extravascular blood. Excess TCLH matrix not associated with blood clot at the epidural space can enhance POSEH development because early clotted hematomas do not drain through suction drains. Korean Society of Spine Surgery 2017-12 2017-12-07 /pmc/articles/PMC5738310/ /pubmed/29279744 http://dx.doi.org/10.4184/asj.2017.11.6.898 Text en Copyright © 2017 by Korean Society of Spine Surgery http://creativecommons.org/licenses/by-nc/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Clinical Study
Ahn, Dong Ki
Shin, Won Shik
Kim, Go We
Koo, Ki Hyuk
Postoperative Spinal Epidural Hematoma: The Danger Caused by the Misuse of Thrombin-Containing Local Hemostatics
title Postoperative Spinal Epidural Hematoma: The Danger Caused by the Misuse of Thrombin-Containing Local Hemostatics
title_full Postoperative Spinal Epidural Hematoma: The Danger Caused by the Misuse of Thrombin-Containing Local Hemostatics
title_fullStr Postoperative Spinal Epidural Hematoma: The Danger Caused by the Misuse of Thrombin-Containing Local Hemostatics
title_full_unstemmed Postoperative Spinal Epidural Hematoma: The Danger Caused by the Misuse of Thrombin-Containing Local Hemostatics
title_short Postoperative Spinal Epidural Hematoma: The Danger Caused by the Misuse of Thrombin-Containing Local Hemostatics
title_sort postoperative spinal epidural hematoma: the danger caused by the misuse of thrombin-containing local hemostatics
topic Clinical Study
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5738310/
https://www.ncbi.nlm.nih.gov/pubmed/29279744
http://dx.doi.org/10.4184/asj.2017.11.6.898
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