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Thromb Haemost 2002; 88(01): 37-40
DOI: 10.1055/s-0037-1613150
Review Article
Schattauer GmbH

Anticoagulant Effect at the Time of Epidural Catheter Removal in Patients Receiving Twice-daily or Once-daily Low-molecular-weight Heparin and Continuous Epidural Analgesia after Orthopedic Surgery

James D. Douketis
1   Department of Medicine, McMaster University and St. Joseph’s Hospital, Hamilton, Canada
,
Krystyna Kinnon
1   Department of Medicine, McMaster University and St. Joseph’s Hospital, Hamilton, Canada
,
Mark A. Crowther
1   Department of Medicine, McMaster University and St. Joseph’s Hospital, Hamilton, Canada
› Author AffiliationsDr. Douketis is the recipient of a Research Scholarship from the Heart and Stroke Foundation of Canada and Dr. Crowther is the recipient of a Research Scholarship from the Canadian Institutes of Health Research
Further Information

Publication History

Received 08 January 2002

Accepted after resubmission 08 March 2002

Publication Date:
09 December 2017 (online)

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Summary

In patients who receive co-administered low-molecular-weight heparin (LMWH) and continuous epidural analgesia (CEA) after orthopedic surgery, there is concern about an increased risk of a spinal epidural hematoma. The practice of twice-daily LMWH dosing in North America might, in part, account for the greater number of epidural hematomas reports compared to Europe where once-daily LMWH is used. We performed a prospective cohort study in patients who had orthopedic surgery and received co-administered LMWH and CEA. We investigated the trough anticoagulant effect, as measured by an anti-Xa heparin level, at the time of epidural catheter removal in patients who received twice-daily or once-daily LMWH. Twenty-five patients who received enoxaparin, 30 mg twice-daily, and 25 patients who received dalteparin, 5,000 IU once-daily, had anti-Xa heparin levels measured on the second or third post-operative day at the time of epidural catheter removal. In patients who received twice-daily enoxaparin, or once-daily dalteparin, the anti-Xa heparin level was measured, on average, 10.4 h and 21.8 h, respectively, after the preceding LWMH dose. All 25 patients who received once-daily LMWH had an anti-Xa heparin level <0.10 U/ml at the time of catheter removal. Of 25 patients who received twice-daily LMWH, the anti-Xa heparin level at the time of catheter removal was >0.20 U/ml in 5 patients (P = 0.050), and >0.10 U/ml in 7 patients (P = 0.009). We conclude that in patients who are receiving co-administered LMWH and CEA after orthopedic surgery, twice-daily but not once-daily LMWH administration is more likely to be associated with a clinically important anticoagulant effect at the time of epidural catheter removal.

Keywords

Low-molecular-weight heparin - epidural analgesia - bleeding - thrombosis
 

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