Potential Antithrombotic Effects of Bupivacaine in Malignancies: An In Vitro Assesment Using Thromboelastography

Thrombosis is a serious complication in patients with gynecologic malignancy. Bupivacaine may have potential beneficial effects on hypercoagulable state in patients with gynecologic malignancies when used either for postoperative analgesia or for intractable pain in terminal cancer patients. The purpose of this study was to investigate the direct effects of bupivacaine in women with gynecologic malignancies. A total of 22 patients with gynecological tumors were included in the study. Thromboelastography analysis was performed with the rotational thromboelastometry for the whole blood samples. Clotting time, clot formation time and maximum clot formation were recorded. In INTEM assay, clotting time and clot formation time values were significantly prolonged with the addition of bupivacaine compared with the non-medicated samples (P<0.05). In comparison with the non-medicated samples, there was a similar significant increase in clotting time, clot formation time values and a decrease in maximum clot formation value in EXTEM assay in the bupivacaine incubated samples (P<0.05). The results suggest that bupivacaine causes hypocoagulable changes on the thromboelastogram profile of gynecologic cancer patients, in vitro.