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Thromboelastography as a perioperative measure of anticoagulation resulting from low molecular weight heparin: a comparison with anti-Xa concentrations.

Publication ,  Journal Article
Klein, SM; Slaughter, TF; Vail, PT; Ginsberg, B; El-Moalem, HE; Alexander, R; D'Ercole, F; Greengrass, RA; Perumal, TT; Welsby, I; Gan, TJ
Published in: Anesth Analg
November 2000

UNLABELLED: Low molecular weight heparin (LMWH) is commonly used to prevent postoperative thromboembolism. Currently, there is no convenient test to measure the degree of anticoagulation from LMWH. This prospective study examines the relationship of thromboelastography and serum anti-Xa concentration in patients treated with enoxaparin. Twenty-four adult patients scheduled for orthopedic surgery using epidural anesthesia were enrolled. Epidural catheters were removed the morning after surgery before the commencement of subcutaneous enoxaparin 30 mg twice daily. Venous blood samples were obtained at 1) the induction of anesthesia (baseline), 2) immediately before the third dose of enoxaparin postoperatively (Day 2-trough), 3) 4 h after the third dose postoperatively (Day 2-peak), and 4) immediately before the fifth dose postoperatively (Day 3-trough). Whole blood samples were obtained for thromboelastography, activated clotting time, and anti-Xa level analyses at each of the four time intervals. At the four sample intervals, the r time (mean +/- SEM). (20 +/- 1, 25 +/- 2, 51 +/- 6, 31 +/- 3 mm) and the k time (9 +/- 0. 7, 12 +/- 1, 27 +/- 5, 14 +/- 2 mm) of the thromboelastograph were significantly correlated with the expected peak and trough levels of LMWH and serum anti-Xa levels (P: < 0.05). At the Day 3-trough, thromboelastograph r times exceeded the normal range in 6 of 25 patients (25%). Prolongation of r time and k time on postoperative Day 3 may indicate an exaggerated response to LMWH. Thromboelastography is a test that could potentially correlate with the degree of anticoagulation produced by low molecular weight heparin. IMPLICATIONS: Thromboelastography is a test that could potentially correlate with the degree of anticoagulation produced by low molecular weight heparin. The r time from the thromboelastogram correlates with serum anti-Xa concentration.

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Published In

Anesth Analg

DOI

ISSN

0003-2999

Publication Date

November 2000

Volume

91

Issue

5

Start / End Page

1091 / 1095

Location

United States

Related Subject Headings

  • Whole Blood Coagulation Time
  • Thrombelastography
  • Prospective Studies
  • Postoperative Period
  • Orthopedic Procedures
  • Male
  • Intraoperative Period
  • Humans
  • Female
  • Factor Xa Inhibitors
 

Citation

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Klein, S. M., Slaughter, T. F., Vail, P. T., Ginsberg, B., El-Moalem, H. E., Alexander, R., … Gan, T. J. (2000). Thromboelastography as a perioperative measure of anticoagulation resulting from low molecular weight heparin: a comparison with anti-Xa concentrations. Anesth Analg, 91(5), 1091–1095. https://doi.org/10.1097/00000539-200011000-00009
Klein, S. M., T. F. Slaughter, P. T. Vail, B. Ginsberg, H. E. El-Moalem, R. Alexander, F. D’Ercole, et al. “Thromboelastography as a perioperative measure of anticoagulation resulting from low molecular weight heparin: a comparison with anti-Xa concentrations.Anesth Analg 91, no. 5 (November 2000): 1091–95. https://doi.org/10.1097/00000539-200011000-00009.
Klein SM, Slaughter TF, Vail PT, Ginsberg B, El-Moalem HE, Alexander R, et al. Thromboelastography as a perioperative measure of anticoagulation resulting from low molecular weight heparin: a comparison with anti-Xa concentrations. Anesth Analg. 2000 Nov;91(5):1091–5.
Klein, S. M., et al. “Thromboelastography as a perioperative measure of anticoagulation resulting from low molecular weight heparin: a comparison with anti-Xa concentrations.Anesth Analg, vol. 91, no. 5, Nov. 2000, pp. 1091–95. Pubmed, doi:10.1097/00000539-200011000-00009.
Klein SM, Slaughter TF, Vail PT, Ginsberg B, El-Moalem HE, Alexander R, D’Ercole F, Greengrass RA, Perumal TT, Welsby I, Gan TJ. Thromboelastography as a perioperative measure of anticoagulation resulting from low molecular weight heparin: a comparison with anti-Xa concentrations. Anesth Analg. 2000 Nov;91(5):1091–1095.

Published In

Anesth Analg

DOI

ISSN

0003-2999

Publication Date

November 2000

Volume

91

Issue

5

Start / End Page

1091 / 1095

Location

United States

Related Subject Headings

  • Whole Blood Coagulation Time
  • Thrombelastography
  • Prospective Studies
  • Postoperative Period
  • Orthopedic Procedures
  • Male
  • Intraoperative Period
  • Humans
  • Female
  • Factor Xa Inhibitors