🩸 Bleeding Complications [Neurosurgery Wiki]

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===== 🩸 Bleeding Complications =====

===== Gastrointestinal bleeding =====
[[Gastrointestinal bleeding]].

==== 📌 Definition ====
Bleeding [[complication]]s refer to **hemorrhagic events** 

==== 🧩 Classification ====
^ Type ^ Description ^ Clinical Impact ^
| **[[Superficial bleeding]]** | [[Subgaleal hematoma]], wound bleeding | Often self-limited, may require drainage |
| **[[Epidural hematoma]]** | Blood collection between dura and skull | Can cause mass effect, requires urgent evacuation |
| **[[Subdural hematoma]]** | Blood between dura and arachnoid | May be acute or delayed, surgical or conservative management |
| **[[Intracerebral hemorrhage]]** | Hemorrhage within brain parenchyma | May be due to vessel injury, coagulation issue; often severe |
| **Rebleeding at surgical site** | Reaccumulation of blood at resection cavity | May need re-craniotomy or intensive care |

==== 📊 Risk Factors ====
  * Intraoperative vessel injury
  * Inadequate hemostasis
  * Use of anticoagulants or antiplatelets
  * Coagulopathy (e.g., thrombocytopenia, liver disease)
  * **[[NSAID]] use (theoretical concern)**
  * Hypertension in the immediate postoperative period

==== ❗ Bleeding Requiring Surgical Intervention ====
Defined as any postoperative hemorrhage that necessitates **reoperation** for evacuation or decompression.

^ Criteria may include: ^
  - Neurological deterioration
  - Midline shift or mass effect on imaging
  - Persistent or increasing hematoma
  - Raised intracranial pressure (ICP)

==== 🔬 NSAIDs and Bleeding Risk ====
Recent evidence (e.g., Cardoso et al., *Neurosurgery* 2025):
  * No statistically significant increase in:
    - All bleeding events (RR 1.05; 95% CI: 0.58–1.93)
    - Surgical reintervention (RR 1.27; 95% CI: 0.51–3.16)
  * Suggests NSAIDs may be **safe for analgesia** post-craniotomy when used judiciously

==== 📌 Monitoring ====
  * Daily neurological examination
  * Blood pressure control
  * Early postoperative imaging (CT/MRI)
  * Hemoglobin levels and coagulation profile