| Risk Factors for Hemorrhagic Stroke in Stereotactic Surgery in Patients with Chronic Renal Failure |
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Yoo Sung Jeon, Joon Cho, Young Il Chun, Chang Taek Moon, Young Cho Koh |
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Department of Neurosurgery, Konkuk University School of Medicine, Seoul, Korea |
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| Abstract |
Objective
Cerebral hemorrhage is the major cause of death in patients with chronic renal failure undergoing dialysis but the underlying reasons have not been clarified. We investigated differences in laboratory test values at the point of hemorrhagic events.
Methods
Thirty-one patients (18 men and 13 women) with chronic renal failure and intracerebral hemorrhage were hospitalized between May 2006 and December 2014. They had received hemodialysis for several years and underwent stereotactic surgery after a hemorrhagic event. Their complete blood cell counts and blood coagulation tests, such as prothrombin time, international normalized ratio, and activated partial thromboplastin time (aPTT) were analyzed. We investigated possible patient-related factors including age, comorbidities, medications, renal function, and coagulopathy. Laboratory test values at 2–3 months, 2 days, and 1 day prior to the event were investigated for any changes.
Results
Patients had a mean age of 61 years. Ten were on anticoagulation or antiplatelet agents, with five on warfarin and five on aspirin. The aPTT increased from 37.45 to 43.33 s immediately before the hemorrhagic event. The platelet count decreased from 188,670 to 171,960 but this was not statistically significant.
Conclusion
Hemorrhagic events in these patients revealed the severity of impaired renal function and change in aPTT as prognostic factors. Thus, regular follow-up is needed to predict complications. There is an increased hemorrhagic risk with a prolonged aPTT and decreased platelet count ; thus, extreme care must be given when using heparin during dialysis. Stereotactic surgery can be considered as a potential treatment that minimizes invasiveness. |
| Key Words:
Renal failure, Dialysis, Cerebral hemorrhage, Partial thromboplastin time, Stereotactic surgery. |
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