Update on hemostasis: neurosurgery

Achieving and maintaining hemostasis in neurosurgical procedures is critical to the outcome. After trauma to the brain, a cascade of events initiated by tissue factor (TF) or thromboplastin results in a coagulation process that develops into an exaggerated fibrinolytic response, called disseminated intravascular coagulation (DIC). After a discussion of DIC, intraoperative adjuncts used to control bleeding, such as the gelatin sponge, thrombin, microcrystalline collagen, aprotinin, and fibrin sealants, are reviewed. Recombinant factor VIIa (rFVIIa) also is discussed, including its mechanism of action and use in neurosurgery. The ultra-early administration of rFVIIa also is covered, in both the military and the civilian settings.