Screening for Platelet Dysfunction and Use of Prophylactic Tranexamic Acid in Patients Undergoing Deep Brain Stimulation: A Retrospective Analysis of Incidence and Outcome of Intracranial Hemorrhage
Introduction: The rate of intracranial hemorrhage (ICH) after deep brain stimulation (DBS) is between 1.5 and 6.1%, with prolonged deficits occurring in 0.4–2.5% of the patients. This retrospective study investigates whether the prophylactic administration of tranexamic acid (TA) to patients with ab...
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Veröffentlicht in: | Stereotactic and functional neurosurgery 2020-06, Vol.98 (3), p.176-181 |
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creator | Helmers, Ann-Kristin Kubelt, Carolin Birkenfeld, Falk Deuschl, Günther Falk, Daniela Mehdorn, Hubertus Maximilian Witt, Karsten Nowak-Göttl, Ulrike Synowitz, Michael Paschen, Steffen |
description | Introduction: The rate of intracranial hemorrhage (ICH) after deep brain stimulation (DBS) is between 1.5 and 6.1%, with prolonged deficits occurring in 0.4–2.5% of the patients. This retrospective study investigates whether the prophylactic administration of tranexamic acid (TA) to patients with abnormal platelet function detected preoperatively by platelet function analyzer (PFA) lowered the risk for an ICH event. Methods: We performed a systematic review of the medical records of 485 consecutively admitted patients who underwent bilateral DBS surgery in a single-center university hospital setting between 2009 and 2018. The cohort was split into two groups. In one group, preoperative PFA screening was performed (n = 156, patients recruited from 2014 to 2018), and TA was administered if platelet function was abnormal. No preoperative PFA was performed in the second group (n = 359, patients recruited from 2009 to 2013). Both cohorts were analyzed for the occurrence of ICH, defined by (i) detection of ICH in routine postoperative magnetic resonance/computed tomography imaging or (ii) in non-routine imaging for the onset of new neurological symptoms. Results: Fourteen of the 156 screened patients (9%) showed reproducible PFA-100 closure abnormalities (3 with von Willebrand disease, 11 with no identifiable cause of platelet dysfunction). Two of the 156 patients (1.3%) in this cohort revealed an ICH on imaging, 1 of whom (0.6%) exhibited a prolonged neurological deficit as a result of ICH. In the cohort without platelet testing, 11 of the 329 patients (3.3%) demonstrated ICH on imaging, of whom 5 (1.5%) suffered from a prolonged neurological deficit. Conclusion: In this retrospective study, the screening and the administration of TA appeared to lower the risk of an ICH by 1.8%. One patient with von Willebrand disease suffered an ICH despite TA treatment. A prospective study is needed to clarify the impact of platelet testing and TA administration on the of incidence ICH. |
doi_str_mv | 10.1159/000505714 |
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This retrospective study investigates whether the prophylactic administration of tranexamic acid (TA) to patients with abnormal platelet function detected preoperatively by platelet function analyzer (PFA) lowered the risk for an ICH event. Methods: We performed a systematic review of the medical records of 485 consecutively admitted patients who underwent bilateral DBS surgery in a single-center university hospital setting between 2009 and 2018. The cohort was split into two groups. In one group, preoperative PFA screening was performed (n = 156, patients recruited from 2014 to 2018), and TA was administered if platelet function was abnormal. No preoperative PFA was performed in the second group (n = 359, patients recruited from 2009 to 2013). Both cohorts were analyzed for the occurrence of ICH, defined by (i) detection of ICH in routine postoperative magnetic resonance/computed tomography imaging or (ii) in non-routine imaging for the onset of new neurological symptoms. Results: Fourteen of the 156 screened patients (9%) showed reproducible PFA-100 closure abnormalities (3 with von Willebrand disease, 11 with no identifiable cause of platelet dysfunction). Two of the 156 patients (1.3%) in this cohort revealed an ICH on imaging, 1 of whom (0.6%) exhibited a prolonged neurological deficit as a result of ICH. In the cohort without platelet testing, 11 of the 329 patients (3.3%) demonstrated ICH on imaging, of whom 5 (1.5%) suffered from a prolonged neurological deficit. Conclusion: In this retrospective study, the screening and the administration of TA appeared to lower the risk of an ICH by 1.8%. One patient with von Willebrand disease suffered an ICH despite TA treatment. A prospective study is needed to clarify the impact of platelet testing and TA administration on the of incidence ICH.</description><identifier>ISSN: 1011-6125</identifier><identifier>EISSN: 1423-0372</identifier><identifier>DOI: 10.1159/000505714</identifier><identifier>PMID: 32224614</identifier><language>eng</language><publisher>Basel, Switzerland</publisher><subject>Adolescent ; Adult ; Aged ; Antifibrinolytic Agents - administration & dosage ; Blood Platelet Disorders - diagnostic imaging ; Blood Platelet Disorders - epidemiology ; Clinical Study ; Deep Brain Stimulation - adverse effects ; Deep Brain Stimulation - trends ; Female ; Humans ; Incidence ; Intracranial Hemorrhages - diagnostic imaging ; Intracranial Hemorrhages - epidemiology ; Intracranial Hemorrhages - prevention & control ; Male ; Mass Screening - methods ; Middle Aged ; Pre-Exposure Prophylaxis - methods ; Preoperative Care - methods ; Prospective Studies ; Retrospective Studies ; Tomography, X-Ray Computed - methods ; Tranexamic Acid - administration & dosage ; Treatment Outcome ; Young Adult</subject><ispartof>Stereotactic and functional neurosurgery, 2020-06, Vol.98 (3), p.176-181</ispartof><rights>2020 S. Karger AG, Basel</rights><rights>2020 S. Karger AG, Basel.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c334t-3debf2457025e474201cd352bece14e5618b08ac63aa3a32a6e28b9ffa0199703</citedby><cites>FETCH-LOGICAL-c334t-3debf2457025e474201cd352bece14e5618b08ac63aa3a32a6e28b9ffa0199703</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,2429,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32224614$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Helmers, Ann-Kristin</creatorcontrib><creatorcontrib>Kubelt, Carolin</creatorcontrib><creatorcontrib>Birkenfeld, Falk</creatorcontrib><creatorcontrib>Deuschl, Günther</creatorcontrib><creatorcontrib>Falk, Daniela</creatorcontrib><creatorcontrib>Mehdorn, Hubertus Maximilian</creatorcontrib><creatorcontrib>Witt, Karsten</creatorcontrib><creatorcontrib>Nowak-Göttl, Ulrike</creatorcontrib><creatorcontrib>Synowitz, Michael</creatorcontrib><creatorcontrib>Paschen, Steffen</creatorcontrib><title>Screening for Platelet Dysfunction and Use of Prophylactic Tranexamic Acid in Patients Undergoing Deep Brain Stimulation: A Retrospective Analysis of Incidence and Outcome of Intracranial Hemorrhage</title><title>Stereotactic and functional neurosurgery</title><addtitle>Stereotact Funct Neurosurg</addtitle><description>Introduction: The rate of intracranial hemorrhage (ICH) after deep brain stimulation (DBS) is between 1.5 and 6.1%, with prolonged deficits occurring in 0.4–2.5% of the patients. This retrospective study investigates whether the prophylactic administration of tranexamic acid (TA) to patients with abnormal platelet function detected preoperatively by platelet function analyzer (PFA) lowered the risk for an ICH event. Methods: We performed a systematic review of the medical records of 485 consecutively admitted patients who underwent bilateral DBS surgery in a single-center university hospital setting between 2009 and 2018. The cohort was split into two groups. In one group, preoperative PFA screening was performed (n = 156, patients recruited from 2014 to 2018), and TA was administered if platelet function was abnormal. No preoperative PFA was performed in the second group (n = 359, patients recruited from 2009 to 2013). Both cohorts were analyzed for the occurrence of ICH, defined by (i) detection of ICH in routine postoperative magnetic resonance/computed tomography imaging or (ii) in non-routine imaging for the onset of new neurological symptoms. Results: Fourteen of the 156 screened patients (9%) showed reproducible PFA-100 closure abnormalities (3 with von Willebrand disease, 11 with no identifiable cause of platelet dysfunction). Two of the 156 patients (1.3%) in this cohort revealed an ICH on imaging, 1 of whom (0.6%) exhibited a prolonged neurological deficit as a result of ICH. In the cohort without platelet testing, 11 of the 329 patients (3.3%) demonstrated ICH on imaging, of whom 5 (1.5%) suffered from a prolonged neurological deficit. Conclusion: In this retrospective study, the screening and the administration of TA appeared to lower the risk of an ICH by 1.8%. One patient with von Willebrand disease suffered an ICH despite TA treatment. A prospective study is needed to clarify the impact of platelet testing and TA administration on the of incidence ICH.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Antifibrinolytic Agents - administration & dosage</subject><subject>Blood Platelet Disorders - diagnostic imaging</subject><subject>Blood Platelet Disorders - epidemiology</subject><subject>Clinical Study</subject><subject>Deep Brain Stimulation - adverse effects</subject><subject>Deep Brain Stimulation - trends</subject><subject>Female</subject><subject>Humans</subject><subject>Incidence</subject><subject>Intracranial Hemorrhages - diagnostic imaging</subject><subject>Intracranial Hemorrhages - epidemiology</subject><subject>Intracranial Hemorrhages - prevention & control</subject><subject>Male</subject><subject>Mass Screening - methods</subject><subject>Middle Aged</subject><subject>Pre-Exposure Prophylaxis - methods</subject><subject>Preoperative Care - methods</subject><subject>Prospective Studies</subject><subject>Retrospective Studies</subject><subject>Tomography, X-Ray Computed - methods</subject><subject>Tranexamic Acid - administration & dosage</subject><subject>Treatment Outcome</subject><subject>Young Adult</subject><issn>1011-6125</issn><issn>1423-0372</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNptkUtv1DAURiNERUthwR4hS2zoIuBXXt0NfUsVHTGddXTj3EwNiR1sBzF_kN-FhwyzYuUr3aPzyfdLkjeMfmQsqz5RSjOaFUw-S06Y5CKlouDP40wZS3PGs-PkpfffIiZkUb5IjgXnXOZMniS_V8ohGm02pLOOLHsI2GMgl1vfTUYFbQ0B05K1R2I7snR2fNr2EBeKPDow-AuGOC6Ubok2ZAlBowmerE2LbmN33kvEkXx2ENeroIcpRkTrOVmQrxic9SNG208kCwP91mu_y7kzUYhG4d_whykoO-C8CA5UDNbQk1scrHNPsMFXyVEHvcfX-_c0WV9fPV7cpvcPN3cXi_tUCSFDKlpsOi6zgvIMZSE5ZaoVGW9QIZOY5axsaAkqFwACBIccedlUXQeUVVVBxWnyYfaOzv6Y0Id60F5h38dL2MnXXJSylBmtWETPZlTFP3qHXT06PYDb1ozWu9rqQ22RfbfXTs2A7YH811ME3s_Ad3AbdAdgdf1lVtRj20Xq7X-pfcofXCaqeA</recordid><startdate>20200601</startdate><enddate>20200601</enddate><creator>Helmers, Ann-Kristin</creator><creator>Kubelt, Carolin</creator><creator>Birkenfeld, Falk</creator><creator>Deuschl, Günther</creator><creator>Falk, Daniela</creator><creator>Mehdorn, Hubertus Maximilian</creator><creator>Witt, Karsten</creator><creator>Nowak-Göttl, Ulrike</creator><creator>Synowitz, Michael</creator><creator>Paschen, Steffen</creator><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20200601</creationdate><title>Screening for Platelet Dysfunction and Use of Prophylactic Tranexamic Acid in Patients Undergoing Deep Brain Stimulation: A Retrospective Analysis of Incidence and Outcome of Intracranial Hemorrhage</title><author>Helmers, Ann-Kristin ; Kubelt, Carolin ; Birkenfeld, Falk ; Deuschl, Günther ; Falk, Daniela ; Mehdorn, Hubertus Maximilian ; Witt, Karsten ; Nowak-Göttl, Ulrike ; Synowitz, Michael ; Paschen, Steffen</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c334t-3debf2457025e474201cd352bece14e5618b08ac63aa3a32a6e28b9ffa0199703</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Antifibrinolytic Agents - administration & dosage</topic><topic>Blood Platelet Disorders - diagnostic imaging</topic><topic>Blood Platelet Disorders - epidemiology</topic><topic>Clinical Study</topic><topic>Deep Brain Stimulation - adverse effects</topic><topic>Deep Brain Stimulation - trends</topic><topic>Female</topic><topic>Humans</topic><topic>Incidence</topic><topic>Intracranial Hemorrhages - diagnostic imaging</topic><topic>Intracranial Hemorrhages - epidemiology</topic><topic>Intracranial Hemorrhages - prevention & control</topic><topic>Male</topic><topic>Mass Screening - methods</topic><topic>Middle Aged</topic><topic>Pre-Exposure Prophylaxis - methods</topic><topic>Preoperative Care - methods</topic><topic>Prospective Studies</topic><topic>Retrospective Studies</topic><topic>Tomography, X-Ray Computed - methods</topic><topic>Tranexamic Acid - administration & dosage</topic><topic>Treatment Outcome</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Helmers, Ann-Kristin</creatorcontrib><creatorcontrib>Kubelt, Carolin</creatorcontrib><creatorcontrib>Birkenfeld, Falk</creatorcontrib><creatorcontrib>Deuschl, Günther</creatorcontrib><creatorcontrib>Falk, Daniela</creatorcontrib><creatorcontrib>Mehdorn, Hubertus Maximilian</creatorcontrib><creatorcontrib>Witt, Karsten</creatorcontrib><creatorcontrib>Nowak-Göttl, Ulrike</creatorcontrib><creatorcontrib>Synowitz, Michael</creatorcontrib><creatorcontrib>Paschen, Steffen</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Stereotactic and functional neurosurgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Helmers, Ann-Kristin</au><au>Kubelt, Carolin</au><au>Birkenfeld, Falk</au><au>Deuschl, Günther</au><au>Falk, Daniela</au><au>Mehdorn, Hubertus Maximilian</au><au>Witt, Karsten</au><au>Nowak-Göttl, Ulrike</au><au>Synowitz, Michael</au><au>Paschen, Steffen</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Screening for Platelet Dysfunction and Use of Prophylactic Tranexamic Acid in Patients Undergoing Deep Brain Stimulation: A Retrospective Analysis of Incidence and Outcome of Intracranial Hemorrhage</atitle><jtitle>Stereotactic and functional neurosurgery</jtitle><addtitle>Stereotact Funct Neurosurg</addtitle><date>2020-06-01</date><risdate>2020</risdate><volume>98</volume><issue>3</issue><spage>176</spage><epage>181</epage><pages>176-181</pages><issn>1011-6125</issn><eissn>1423-0372</eissn><abstract>Introduction: The rate of intracranial hemorrhage (ICH) after deep brain stimulation (DBS) is between 1.5 and 6.1%, with prolonged deficits occurring in 0.4–2.5% of the patients. This retrospective study investigates whether the prophylactic administration of tranexamic acid (TA) to patients with abnormal platelet function detected preoperatively by platelet function analyzer (PFA) lowered the risk for an ICH event. Methods: We performed a systematic review of the medical records of 485 consecutively admitted patients who underwent bilateral DBS surgery in a single-center university hospital setting between 2009 and 2018. The cohort was split into two groups. In one group, preoperative PFA screening was performed (n = 156, patients recruited from 2014 to 2018), and TA was administered if platelet function was abnormal. No preoperative PFA was performed in the second group (n = 359, patients recruited from 2009 to 2013). Both cohorts were analyzed for the occurrence of ICH, defined by (i) detection of ICH in routine postoperative magnetic resonance/computed tomography imaging or (ii) in non-routine imaging for the onset of new neurological symptoms. Results: Fourteen of the 156 screened patients (9%) showed reproducible PFA-100 closure abnormalities (3 with von Willebrand disease, 11 with no identifiable cause of platelet dysfunction). Two of the 156 patients (1.3%) in this cohort revealed an ICH on imaging, 1 of whom (0.6%) exhibited a prolonged neurological deficit as a result of ICH. In the cohort without platelet testing, 11 of the 329 patients (3.3%) demonstrated ICH on imaging, of whom 5 (1.5%) suffered from a prolonged neurological deficit. Conclusion: In this retrospective study, the screening and the administration of TA appeared to lower the risk of an ICH by 1.8%. One patient with von Willebrand disease suffered an ICH despite TA treatment. A prospective study is needed to clarify the impact of platelet testing and TA administration on the of incidence ICH.</abstract><cop>Basel, Switzerland</cop><pmid>32224614</pmid><doi>10.1159/000505714</doi><tpages>6</tpages></addata></record> |
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subjects | Adolescent Adult Aged Antifibrinolytic Agents - administration & dosage Blood Platelet Disorders - diagnostic imaging Blood Platelet Disorders - epidemiology Clinical Study Deep Brain Stimulation - adverse effects Deep Brain Stimulation - trends Female Humans Incidence Intracranial Hemorrhages - diagnostic imaging Intracranial Hemorrhages - epidemiology Intracranial Hemorrhages - prevention & control Male Mass Screening - methods Middle Aged Pre-Exposure Prophylaxis - methods Preoperative Care - methods Prospective Studies Retrospective Studies Tomography, X-Ray Computed - methods Tranexamic Acid - administration & dosage Treatment Outcome Young Adult |
title | Screening for Platelet Dysfunction and Use of Prophylactic Tranexamic Acid in Patients Undergoing Deep Brain Stimulation: A Retrospective Analysis of Incidence and Outcome of Intracranial Hemorrhage |
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