[Pharmacologic treatment for 2 thrombocytopenic patients prior to neurosurgery]. / Tratamiento farmacológico preoperatorio de dos pacientes trombopénicos para intervención neuroquirúrgica.

Preoperative prophylaxis of hemorrhage for patients with thrombocytopenia or a platelet disorder is controversial. Platelet count correlates to a certain degree with risk of hemorrhage, and risk factors for hemorrhage should be assessed and treated before deciding on perioperative treatments. Thirteen percent of cirrhotic patients have a platelet count between 50,000 and 75,000/microL and thrombocytopenia is multifactorial in origin. Idiopathic thrombocytopenic purpura is an acquired disease; since it may be either primary or secondary to other conditions, treatment may vary considerably. No clinical method has been established for predicting risk of perioperative bleeding in patients with thrombocytopenia. We describe 2 thrombocytopenic patients scheduled for intracranial surgery who were treated with thrombopoietic growth factors; in both cases, platelet counts increased sufficiently for this type of surgery. Controlled clinical trials are needed to ascertain the safety and prophylactic utility of platelet transfusion and thrombopoietin analogs in certain situations of refractory thrombocytopenia.

Tratamiento farmacol¨®gico preoperatorio de dos pacientes trombop¨¦nicos para intervenci¨®n neuroquir¨²rgica / Pharmacologic treatment for 2 thrombocytopenic patients prior to neurosurgery

El tratamiento y la profilaxis de la hemorragia del paciente con trombopenia o con alteraciones de la funci¨®n plaquetaria son controvertidos. El recuento plaquetario se correlaciona parcialmente con el riesgo hemorr¨¢gico. Existen factores de riesgo hemorr¨¢gico que deben ser evaluados y tratados antes de decidir el tratamiento perioperatorio. El 13% de los pacientes cirr¨®ticos tienen un recuento de plaquertas entre 50.000-75.000/¦ÌL, siendo la trombopenia de origen multifactorial. La p¨²rpura trombop¨¦nica idiop¨¢tica, PTI, es una enfermedad adquirida bien de forma primaria o secundaria a otras enfermedades, siendo la evoluci¨®n y el tratamiento de ambas formas bastante diferente. No hay m¨¦todos cl¨ªnicos que predigan el riesgo de hemorragia perioperatoria en pacientes con trombopenia. Se presentan dos casos de pacientes con trombopenia programados para cirug¨ªa intracraneal, tratados con factores de crecimiento de la trombopoyesis. En ambos casos se consigui¨® un recuento plaquetar acorde al tipo de intervenci¨®n. Se necesitan ensayos cl¨ªnicos controlados que determinen la seguridad, la utilidad profil¨¢ctica de la transfusi¨®n de plaquetas y de los an¨¢logos de la trombopoyetina en algunas situaciones refractarias de trombopenia(AU)

Preoperative prophylaxis of hemorrhage for patients with thrombocytopenia or a platelet disorder is controversial. Platelet count correlates to a certain degree with risk of hemorrhage, and risk factors for hemorrhage should be assessed and treated before deciding on perioperative treatments. Thirteen percent of cirrhotic patients have a platelet count between 50 000 and 75 000/¦ÌL and thrombocytopenia is multifactorial in origin. Idiopathic thrombocytopenic purpura is an acquired disease; since it may be either primary or secondary to other conditions, treatment may vary considerably. No clinical method has been established for predicting risk of perioperative bleeding in patients with thrombocytopenia. We describe 2 thrombocytopenic patients scheduled for intracranial surgery who were treated with thrombopoietic growth factors; in both cases, platelet counts increased sufficiently for this type of surgery. Controlled clinical trials are needed to ascertain the safety and prophylactic utility of platelet transfusion and thrombopoietin analogs in certain situations of refractory thrombocytopenia(AU)