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British Journal of Anaesthesia, 2001, Vol. 86, No. 6 808-813
© 2001 The Board of Management and Trustees of the British Journal of Anaesthesia

Does prior administration of enoxaparin influence the effects of levobupivacaine on blood clotting? Assessment using the Thrombelastograph®

S. A. Leonard1, A. Lydon2, M. Walsh3, C. Fleming4, J. Boylan2 and G. D. Shorten1

1Department of Anaesthesia and Intensive Care Medicine, Cork University Hospital and University College, Cork, Ireland. 2Department of Anaesthesia, St Vincent’s Hospital, Dublin, Ireland. 3Department of Anaesthesia, Our Lady’s Hospital for Sick Children, Crumlin, Dublin, Ireland. 4Department of Biochemistry, St Vincent’s Hospital, Dublin, Ireland*Corresponding author

The low molecular weight heparin, enoxaparin (by inhibition of factors Xa and IIa) and amide local anaesthetics (by altering platelet function) exert anti-clotting effects. Although these agents are often used in combination during the perioperative period, their potential interactive effect on clotting has not been defined. Blood from 10 ASA I–II patients who received enoxaparin 0.5 mg kg–1 s.c. was studied using a Thrombelastograph (TEG®) either alone or in combination with levobupivacaine (2.5 mg ml–1 or 2.5 µg ml–1) or saline (50% dilution). In blood from patients who had received enoxaparin 0.5 mg kg–1 s.c. 12 h previously, levobupivacaine 2.5 mg ml–1 (but not 2.5 µg ml–1) produced significant changes in TEG clotting parameters (mean (SD) 15.7 (4.8) mm, 29.6 (25.6) mm, 34.4 (14.6) mm, 34.3 (12.2)° compared with control values of 6.1 (1.3) mm, 2.5 (0.5) mm, 63.5 (6.4) mm and 74.1 (2.9)° for r, K, MA, and {alpha} angle respectively).

Br J Anaesth 2001; 86: 808–13


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