🩸 Bleeding Complications
Gastrointestinal bleeding
📌 Definition
Bleeding complications 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