SAH術後管理における低分子デキストランのピットフォール  [in Japanese] Problems of Using Low Molecular Dextran in Post-operative Management of Subarachnoid Hemorrhage  [in Japanese]

Low molecular dextran is often used in post-operative management of subarachnoid hemorrhage (SAH) to induce hypervolemia and hemodilution; however, its associated complications are not well-known. We retrospectively analyzed prothrombin time (PT%), activated partial thromboplastin time (APTT%), and fibrinogen level as coagulation markers in patients with subarachnoid hemorrhage who developed delayed intracranial hemorrhagic complications after undergoing craniotomy for clipping to examine the effect of long-term use of low molecular dextran on bleeding tendencies. Fifty-two patients with SAH who underwent craniotomy were divided into 2 groups: 26 without postoperative use of low molecular dextran (Group 1) and 26 to whom low molecular dextran was administered for more than 5 consecutive days (Group 2). Group 2 was further divided into 2 subgroups: those who developed hemorrhagic complications (Group 2A) and those without complications (Group 2B). The frequency of complications in Group 2A was 19% (5/26; 3 with subdural hematoma and epidural hematoma, 1 with epidural hematoma, and 1 with intracerebral hematoma). Complications appeared 7.6 days on average after starting low molecular dextran. Compared with Group 1, PT% and APTT% as well as pre- and post-low molecular dextran administration fibrinogen levels significantly decreased in Group 2A. Low molecular dextran is known to decrease fibrinogen levels, and patients' clinicai conditions and changes in fibrinogen levels should be closely monitored to detect bleeding tendencies when low molecular dextran must be used for long periods.