Hemostatic changes in pediatric neurosurgical patients as evaluated by Thrombelastograph (R)

Thromboembolic events are a known complication in neurosurgical patients. T here is evidence to suggest that a hypercoagulable state may develop periop eratively. Thrombelastograph (R) (TEG (R)) coagulation analysis is a reliab le method of evaluating hypercoagulability. We evaluated coagulation by usi ng TEG (R) data in pediatric neurosurgical patients undergoing craniotomy t o determine whether a hypercoagulable state develops intraoperatively or po stoperatively. Thirty children undergoing craniotomy for removal of a tumor or seizure focus were studied. Blood was analyzed with TEG (R) data by usi ng native and celite techniques, at three time points for each patient: pre operatively after induction of anesthesia; intraoperatively during closure of the dura; and on the first postoperative day. Compared with preoperative indices, closing and postoperative celite TEG (R) values were indicative o f hypercoagulability with shortened coagulation time values (P < 0.001), pr olonged alpha angle divergence values (P < 0.001), and above-normal TEG<(R) > coagulation indices (P less than or equal to 0.002). Reaction time values were shortened, and maximal amplitude of clot strength values were prolong ed but did not reach statistical significance. Hypercoagulation develops ea rly after resection of brain tissue in pediatric neurosurgical patients as assessed by using TEG (R) data. Further studies are needed to determine the clinical significance of this hypercoagulable state.