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Epidural Anesthesia Prevents Hypercoagulation in Patients Undergoing Major Orthopedic Surgery
  1. Markus W. Hollmann, M.D.,
  2. Kathrin S. Wieczorek, M.S.,
  3. Mary Smart, M.D. and
  4. Marcel E. Durieux, M.D., Ph.D.
  1. From the Department of Anesthesiology, University of Virginia (M.W.H., K.S.W., M.S., M.E.D.), Charlottesville, Virginia; the Department of Anesthesiology, University of Heidelberg, (M.W.H., K.S.W.), Heidelberg, Germany; and the Department of Anesthesiology, University of Maastricht (M.E.D.), Maastricht, The Netherlands.
  1. Reprint requests: Marcel E. Durieux, M.D., Ph.D., Department of Anesthesiology, University of Maastricht, PO Box 5800, 6202 AZ Maastricht, The Netherlands. E-mail: mdu@sane.azm.nl

Abstract

Background and Objectives Epidural anesthesia (EA) is known to reduce postoperative thromboembolic complications, but mechanisms are incompletely understood. In this study, we tested the hypothesis that local anesthetics (LA) prevent postoperative hypercoagulability without affecting physiologic aggregation and coagulation processes.

Methods Clot signature analysis (CSA) was used to assess platelet and clotting function. Venous blood samples were collected pre- and postoperatively from 41 patients undergoing major orthopedic surgery. The effect of surgery on 3 CSA parameters (platelet-mediated hemostasis time [PHT], clotting time [CT], and collagen-induced thrombus formation [CITF]) was determined in patients receiving EA (n = 20) and those receiving general anesthesia (GA) (n = 21).

Results In the GA group, orthopedic surgery induced a hypercoagulable state: PHT was reduced by 39% ± 8.6% (P <.001), CT by 21% ± 3.3% (P < .001), CITF by 10.3% ± 5.9% (P = .06) compared with respective baseline values. In the EA group, by contrast, no parameter was altered significantly, but PHT showed a tendency towards prolongation by 33.2% ± 15.4% (P = .25). CT changed by 0% ± 4.4% (P = .89), CITF by 3.8% ± 7% (P = .78).

Conclusions Use of EA prevents immediate postoperative hypercoagulability without affecting physiologic aggregation and coagulation processes. Also, CSA appears useful in predicting hypercoagulability and detecting platelet dysfunction.

  • Coagulation
  • Local anesthetics
  • Platelet function test
  • Clot signature analysis

https://doi.org/10.1053/rapm.2001.23209

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    Footnotes

    • M.W.H. is supported in part by the Department of Anesthesiology), University of Heidelberg, Heidelberg, Germany and by a grant from the German Research Society (DFG HO 2199/1-1), Bonn, Germany. Supported in part by an American Heart Association grant, Mid-Atlantic Affiliation (VHA 9920345U), Baltimore, MD, and National Institutes of Health Grant No. GMS 52387, Bethesda, MD. Supported in part by the 2000 BenCovino Research Award to M.W.H., sponsored by AstraZeneca Pain Control, Huddinge, Sweden.