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The influence of cerebrospinal fluid on blood coagulation and the implications for ventriculovenous shunting

(2019) JOURNAL OF NEUROSURGERY. 130(4). p.1244-1251
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Abstract
OBJECTIVE: The effect of CSF on blood coagulation is not known. Enhanced coagulation by CSF may be an issue in thrombotic complications of ventriculoatrial and ventriculosinus shunts. This study aimed to assess the effect of CSF on coagulation and its potential effect on thrombotic events affecting ventriculovenous shunts. METHODS: Two complementary experiments were performed. In a static experiment, the effect on coagulation of different CSF mixtures was evaluated using a viscoelastic coagulation monitor. A dynamic experiment confirmed the amount of clot formation on the shunt surface in a roller pump model. RESULTS: CSF concentrations of 9% and higher significantly decreased the activated clotting time (ACT; 164.9 seconds at 0% CSF, 155.6 seconds at 9% CSF, and 145.1 seconds at 32% CSF). Increased clot rates (CRs) were observed starting at a concentration of 5% (29.3 U/min at 0% CSF, 31.6 U/min at 5% CSF, and 35.3 U/min at 32% CSF). The roller pump model showed a significantly greater percentage of shunt surface covered with deposits when the shunts were infused with CSF rather than Ringer's lactate solution (90% vs 63%). The amount of clot formation at the side facing the blood flow (impact side) tended to be lower than that at the side facing away from the blood flow (wake side; 71% vs 86%). CONCLUSIONS: Addition of CSF to blood accelerates coagulation. The CSF-blood-foreign material interaction promotes clot formation, which might result in thrombotic shunt complications. Further development of the ventriculovenous shunt technique should focus on preventing CSF-blood-foreign material interaction and stagnation of CSF in wake zones.
Keywords
cerebrospinal fluid, coagulation, hydrocephalus, ventriculoatrial shunt, ventriculosinus shunt, CENTRAL VENOUS CATHETERS, VENTRICULOATRIAL, HYDROCEPHALUS, THROMBOSIS, INFANTS

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Citation

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MLA
Vandersteene, Jelle, et al. “The Influence of Cerebrospinal Fluid on Blood Coagulation and the Implications for Ventriculovenous Shunting.” JOURNAL OF NEUROSURGERY, vol. 130, no. 4, 2019, pp. 1244–51.
APA
Vandersteene, J., Baert, E., Planckaert, G., Van Den Berghe, T., Van Roost, D., Dewaele, F., … De Somer, F. (2019). The influence of cerebrospinal fluid on blood coagulation and the implications for ventriculovenous shunting. JOURNAL OF NEUROSURGERY, 130(4), 1244–1251.
Chicago author-date
Vandersteene, Jelle, Edward Baert, Guillaume Planckaert, Thomas Van Den Berghe, Dirk Van Roost, Frank Dewaele, Michaël Henrotte, and Filip De Somer. 2019. “The Influence of Cerebrospinal Fluid on Blood Coagulation and the Implications for Ventriculovenous Shunting.” JOURNAL OF NEUROSURGERY 130 (4): 1244–51.
Chicago author-date (all authors)
Vandersteene, Jelle, Edward Baert, Guillaume Planckaert, Thomas Van Den Berghe, Dirk Van Roost, Frank Dewaele, Michaël Henrotte, and Filip De Somer. 2019. “The Influence of Cerebrospinal Fluid on Blood Coagulation and the Implications for Ventriculovenous Shunting.” JOURNAL OF NEUROSURGERY 130 (4): 1244–1251.
Vancouver
1.
Vandersteene J, Baert E, Planckaert G, Van Den Berghe T, Van Roost D, Dewaele F, et al. The influence of cerebrospinal fluid on blood coagulation and the implications for ventriculovenous shunting. JOURNAL OF NEUROSURGERY. 2019;130(4):1244–51.
IEEE
[1]
J. Vandersteene et al., “The influence of cerebrospinal fluid on blood coagulation and the implications for ventriculovenous shunting,” JOURNAL OF NEUROSURGERY, vol. 130, no. 4, pp. 1244–1251, 2019.
@article{8560553,
  abstract     = {OBJECTIVE: The effect of CSF on blood coagulation is not known. Enhanced coagulation by CSF may be an issue in thrombotic complications of ventriculoatrial and ventriculosinus shunts. This study aimed to assess the effect of CSF on coagulation and its potential effect on thrombotic events affecting ventriculovenous shunts. 
METHODS: Two complementary experiments were performed. In a static experiment, the effect on coagulation of different CSF mixtures was evaluated using a viscoelastic coagulation monitor. A dynamic experiment confirmed the amount of clot formation on the shunt surface in a roller pump model. 
RESULTS: CSF concentrations of 9% and higher significantly decreased the activated clotting time (ACT; 164.9 seconds at 0% CSF, 155.6 seconds at 9% CSF, and 145.1 seconds at 32% CSF). Increased clot rates (CRs) were observed starting at a concentration of 5% (29.3 U/min at 0% CSF, 31.6 U/min at 5% CSF, and 35.3 U/min at 32% CSF). The roller pump model showed a significantly greater percentage of shunt surface covered with deposits when the shunts were infused with CSF rather than Ringer's lactate solution (90% vs 63%). The amount of clot formation at the side facing the blood flow (impact side) tended to be lower than that at the side facing away from the blood flow (wake side; 71% vs 86%). 
CONCLUSIONS: Addition of CSF to blood accelerates coagulation. The CSF-blood-foreign material interaction promotes clot formation, which might result in thrombotic shunt complications. Further development of the ventriculovenous shunt technique should focus on preventing CSF-blood-foreign material interaction and stagnation of CSF in wake zones.},
  author       = {Vandersteene, Jelle and Baert, Edward and Planckaert, Guillaume and Van Den Berghe, Thomas and Van Roost, Dirk and Dewaele, Frank and Henrotte, Michaël and De Somer, Filip},
  issn         = {0022-3085},
  journal      = {JOURNAL OF NEUROSURGERY},
  keywords     = {cerebrospinal fluid,coagulation,hydrocephalus,ventriculoatrial shunt,ventriculosinus shunt,CENTRAL VENOUS CATHETERS,VENTRICULOATRIAL,HYDROCEPHALUS,THROMBOSIS,INFANTS},
  language     = {eng},
  number       = {4},
  pages        = {1244--1251},
  title        = {The influence of cerebrospinal fluid on blood coagulation and the implications for ventriculovenous shunting},
  url          = {http://dx.doi.org/10.3171/2017.11.jns171510},
  volume       = {130},
  year         = {2019},
}

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