Article
Occurence and recurrence of chronic subdural hematoma are associated with deficiency of Factor XIII activity
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Published: | April 28, 2011 |
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Objective: Chronic subdural hematoma (cSDH) may occur spontaneously and may occasionally be followed by re-bleeding. Its pathophysiology, however, is poorly understood. Since the coagulation factor XIII (FXIII) is additionally involved in angiogenesis, endothelial barrier function and wound healing, we evaluated a potential role of FXIII in cSDH and its recurrence.
Methods: We analyzed the initial plasma activity of FXIII and standard coagulation parameters of 36 individuals (18 cSDH-patients/18 healthy controls). In addition, we assessed clinical data, the number of hematoma compartments, the approximate volume of cSDH and the occurrence of a relevant re-bleeding requiring a second neurosurgical treatment. Typical risk factors for cSDH were excluded.
Results: All cSDH-patients had none or just a negligible trauma. Six patients had bilateral and 12 unilateral cSDH. CSDH-patients showed significantly lower FXIII activities than the control group (65 [52.75-80.25] % vs. 93 [81-111] %, p = 0.001), whereas standard coagulation parameters showed no significant differences. Six patients developed a relevant re-bleeding after treatment requiring repeated surgery. These patients expressed a significantly lower initial FXIII activity compared to the other 12 cSDH-patients (47.5 [33.5-64] % vs. 78.5 [58-87] %, p = 0.005). A cut-off value of FXIII less than 68.5% was identified as the best predictor for a relevant re-bleeding (sensitivity: 100%, specificity: 75%, p = 0.007).
Conclusions: FXIII may play a relevant role in the pathophysiology of cSDH, although it remains uncertain, whether the FXIII deficiency is the cause or an epiphenomenon of cSDH. However, its substitution may serve as a therapeutic option to prevent re-bleedings.