Rotational thromboelastometry and multiple electrode platelet aggregometry in four patients with abnormal routine coagulation studies before removal of epidural catheters after major surgery: a case series and research study.

Most guidelines in the field recommend epidural catheter removal at the anticoagulant’s trough level or after a specific time interval (about 2 half-lives) after the last administration of anticoagulant. Since drug elimination and interactions may be multiple in the postoperative setting it would indeed be interesting to have a drug-sensitive monitoring test available to confirm cessation of the biological effect of the anticoagulant at catheter removal. Furthermore, coagulation tests assessing overall hemostatic competence, aside from drug effects, would make decision making even easier.

The authors describe PT/INR, aPTT, platelet counts, conventional ROTEM tests, and Multiplate in a small collection of 20 case of uneventful epidural catheter removal. Applicability of the results is limited because these tests are not sensitive to LMWH. Hopefully, other tests such as anti-Xa activity, PiCT NATEM, or low TF EXTEM will be employed in an upcoming large study and drug withdrawal intervals will be reported.

– Sibylle Kozek-Langenecker