Department of Traumatology, National Taiwan University Hospital, No. 7, Chung Shan S. Rd., Taipei, 100225, Taiwan.
Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
Sci Rep. 2022 Aug 26;12(1):14625. doi: 10.1038/s41598-022-18992-1.
Normal hemostatic function is important for reduction of the risk of intracranial hemorrhage during stereotactic neurosurgery including deep brain stimulation (DBS) surgery. This study investigates the hemostatic function in patients with Parkinson's disease (PD) undergoing preoperative evaluation for DBS, with emphasis on the number and function of platelets. In 107 PD patients, only one had abnormal activated partial prothrombin time and normal prothrombin time. Among the other 106 patients, six (5.7%) had only thrombocytopenia, seven (6.6%) only prolonged bleeding time (BT), and 14 (13.2%) only prolonged closure time (CT) of platelet function analyzer 100 (PFA-100). Totally, 34 of the 106 patients (32.1%) had at least one of three kinds of platelet abnormalities. No factor was found to be associated with the occurrence of platelet abnormalities except that abnormal platelet group and prolonged BT subgroup had more patients using selegiline and lower UPDRS-III motor subscore with medication off than normal platelet group (p < 0.05). The use of selegiline was significantly correlated with prolonged BT (p = 0.0041) and platelet abnormality (p = 0.0197). Therefore, it is important to have detailed evaluation of the hemostatic function for PD patients undergoing preoperative evaluation for DBS, especially the platelet number and function.
正常的止血功能对于降低立体定向神经外科手术（包括脑深部刺激术，DBS）中颅内出血的风险非常重要。本研究调查了接受 DBS 术前评估的帕金森病（PD）患者的止血功能，重点关注血小板的数量和功能。在 107 例 PD 患者中，仅有 1 例患者活化部分凝血活酶时间异常，而凝血酶原时间正常。在其余 106 例患者中，仅 6 例（5.7%）存在单纯血小板减少症，7 例（6.6%）存在单纯出血时间延长（BT），14 例（13.2%）存在单纯血小板功能分析仪 100 （PFA-100）的闭合时间延长（CT）。总的来说，106 例患者中有 34 例（32.1%）至少存在三种血小板异常中的一种。除了异常血小板组和延长 BT 亚组在停药时使用司来吉兰的患者更多，且 UPDRS-III 运动评分更低外，未发现任何因素与血小板异常的发生有关（p < 0.05）。司来吉兰的使用与 BT 延长（p = 0.0041）和血小板异常（p = 0.0197）显著相关。因此，对于接受 DBS 术前评估的 PD 患者，详细评估止血功能非常重要，尤其是血小板的数量和功能。
