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Vandersteene J, Baert E, Planckaert GMJ, et al. The influence of cerebrospinal fluid on blood coagulation and the implications for ventriculovenous shunting. J Neurosurg. 2018;1-8doi: 10.3171/2017.11.JNS171510.
Vandersteene, J., Baert, E., Planckaert, G. M. J., Van Den Berghe, T., Van Roost, D., Dewaele, F., Henrotte, M. M. D. M., & De Somer, F. (2018). The influence of cerebrospinal fluid on blood coagulation and the implications for ventriculovenous shunting. Journal of neurosurgery, 1-8. https://doi.org/10.3171/2017.11.JNS171510
Vandersteene, Jelle, et al. "The influence of cerebrospinal fluid on blood coagulation and the implications for ventriculovenous shunting." Journal of neurosurgery vol. (2018): 1-8. doi: https://doi.org/10.3171/2017.11.JNS171510
Vandersteene J, Baert E, Planckaert GMJ, Van Den Berghe T, Van Roost D, Dewaele F, Henrotte MMDM, De Somer F. The influence of cerebrospinal fluid on blood coagulation and the implications for ventriculovenous shunting. J Neurosurg. 2018 Apr 01;1-8. doi: 10.3171/2017.11.JNS171510. Epub 2018 Apr 01. PMID: 29701547.
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J Neurosurg. 2018 Apr 01;1-8. doi: 10.3171/2017.11.JNS171510. Epub 2018 Apr 01.

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

Journal of neurosurgery

Jelle Vandersteene, Edward Baert, Guillaume M J Planckaert, Thomas Van Den Berghe, Dirk Van Roost, Frank Dewaele, Michaël M D M Henrotte, Filip De Somer

Affiliations

  1. Departments of1Neurosurgery and.
  2. 2Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
  3. 3Cardiac Surgery, Ghent University Hospital; and.

PMID: 29701547 DOI: 10.3171/2017.11.JNS171510

Abstract

OBJECTIVEThe 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.METHODSTwo 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.RESULTSCSF 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%).CONCLUSIONSAddition 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: ACT = activated clotting time; CR = clot rate; EVD = external ventricular drainage; PF = platelet function; Ratioimpact = (total area of clots on the impact side)/(total visualized area of the impact side of the shunt); Ratiototal = (total area of clots on the impact + wake side)/(total visualized area of the impact + wake side of the shunt); Ratiowake = (total surface of clots on the wake side)/(total visualized surface of the wake side of the shunt); cerebrospinal fluid; coagulation; hydrocephalus; ventriculoatrial shunt; ventriculosinus shunt

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