Factor XIII deficiency and postoperative hemorrhage after neurosurgical procedures

BACKGROUND Factor XIII is of physiological importance for hemostasis, especially in pa tients undergoing surgery. it catalyzes the enzymatic cross-linking of fibr in monomers into stable polymers and protects polymers from plasmatic and n onspecific degradation. Postoperative hemorrhage in patients with congenita l and acquired Factor XIII deficiencies has been described in various surgi cal fields. However, there are no data about the incidence and clinical rel evance of decreased Factor XIII after neurosurgical procedures. The objecti ve of our study was to investigate the association between Factor XIII defi ciency and postoperative hemorrhage after intracranial surgery. METHODS A total of 1264 patients who underwent intracranial operations were reviewe d retrospectively Standard coagulation parameters were monitored during the perioperative course in all patients. Factor XIII testing was performed po stoperatively in 34 patients in whom coagulopathies were suspected despite normal platelets, fibrinogen, prothrombin, and partial thromboplastin time. Data were analyzed to evaluate the association of Factor XIII deficiency a nd major postoperative hemorrhage. RESULTS In this series of 1264 patients, a total of 20 patients (1.6%) suffered fro m a major postoperative hemorrhage. Of the 34 patients with suspected coagu lopathies and postoperative Factor XIII testing, II had a major postoperati ve hemorrhage. Normal levels of Factor XIII, defined as more than 60%, were found in 26 of the 34 patients. Factor XIII deficiency, defined as less th an 60%, was found in eight patients. AII patients with Factor XIII deficien cy (n = 8) had a major postoperative hemorrhage. Of the remaining 26 patien ts with normal Factor XIII levels only three had a postoperative hemorrhage (p < 0.00001, Fisher's exact test). CONCLUSIONS Decreased Factor XIII activity may be associated with an increa sed risk of postoperative hemorrhage after intracranial surgery. (C) 2000 b y Elsevier Science Inc.