Author(s): Srinivasaiah R.; Masters J.; Nair V.

Source: Journal of Neurosurgical Anesthesiology; Oct 2019; vol. 31 (no. 4); p. 479

Publication Date: Oct 2019

Publication Type(s): Conference Abstract

Abstract:Introduction: Guidelines are available for managing the preoperative anemia in Neurosurgical patients, however, no such guidelines are available for the management of anemia in Interventional Neuro Radiology (INR) patients. INR procedures are associated with significant mortality and morbidity. These patients are routinely commenced on dual antiplatelet therapy to prevent the thromboembolic complications associated with the procedure. The aim of the study was to establish the prevalence of periprocedural anemia in INR patients in our hospital. Method(s): We obtained permission from the hospital’s clinical governance department to conduct a retrospective study on prevalence of periprocedural anemia in INR patients undergoing elective treatment of intracranial aneurysm. We collected the data for 100 consecutive patients between July 2018 and January 2019 for a 6-month period. We collected patient’s demographic details, pre, and postprocedure hemoglobin and hematocrit. Result(s): The data of 100 consecutive patients was gathered, of which 70 were female individuals and 30 were male individuals. The age distribution ranged from 23 to 74 years. 42% of the patients were found to be anemic preprocedure with a hemoglobin <130 gm/L, this incidence increased to whopping 78% on day 1 of postprocedure. Preprocedure mean hemoglobin was 133.77 gm/L with a SD of 13.54, however, the mean hemoglobin on postprocedure was 118.33 gm/L with a SD of 14.84. Hematocrit values were compared as well, the mean preprocedure hematocrit was 0.3867 with a SD of 0.0407, while the post-procedure day 1 mean hematocrit was 0.3469 with a SD of 0.0425. Discussion(s): There is a statistically significant difference between preprocedure and postprocedure values of both hemoglobin and hematocrit in patients undergoing elective INR procedures (P<0.0001). This significant drop in hemoglobin can be attributed to combinations of periprocedure factors, namely preprocedure loading of dual antiplatelet drugs, use of intravenous aspirin, heparin during the procedure, use of large amounts of IV fluids during the procedure and lastly the incidence of groin hematoma is often understated. We need a well designed study to ascertain how much each factors contribute to the drop in hemoglobin in INR patients. Significant proportion of patients in the study group had a postprocedure hemoglobin of <100 gm/L. As we know cerebral oxygenation is an important goal in the management of any neurosurgical or INR procedures. By causing a significant drop in hemoglobin we are impairing cerebral oxygenation. Therefore we recommend pre procedure anaemia in INR patients should be thoroughly investigated and treated if necessary to optimize these patients.

Database: EMBASE