Evaluation of Coagulation in the Neurosurgery Patient

Abstract

Normal hemostasis provides for balanced interactions between the blood vessel wall, coagulation proteins, and platelets. After vascular injury, primary hemostasis and secondary hemostasis function in a coordinated fashion to stop bleeding. Standard coagulation tests have been shown in multiple studies to predict bleeding and mortality in neurosurgical patients. Emerging coagulation tests are useful point-of-care assays that guide transfusion therapy and diagnose patients with hyperfibrinolysis. This article provides an overview of hemostasis, a summary of standard coagulation testing and point-of-care tests, and a brief review of coagulation test usefulness in neurosurgery, focusing on studies in patients with traumatic brain injury.

Keywords: Coagulation testing; Fibrinolysis; Hemostasis; Rotational elastometry; Thromboelastography; Traumatic brain injury; Viscoelastic assays.