Testing a New Anticoagulation Method for Free Flap Reconstruction of Head and Neck Cancers

Karimi, Ebrahim; Ardestani, Seyyed Hadi Samimi; Jafari, Mehrdad; Hagh, Ali Bagheri

doi:10.21053/ceo.2015.01781

Cited by 9 publications

(11 citation statements)

References 24 publications

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“…Multiple studies have addressed the effect of LMWH on flap outcomes. In a study of 30 head and neck microvascular patients, Karimi et al demonstrated the utility of a combination protocol of aspirin and enoxaparin for 5 and 3 days, respectively, for flap survival, with no incidence of flap loss or hematoma 58. A retrospective study of 137 microvascular reconstruction patients demonstrated that LMWH is an effective standalone antithrombotic, with outcomes comparable to those of HSQ and aspirin studies and a flap survival rate of 97.1% 59.…”

Section: Resultsmentioning

confidence: 99%

“…In a study of 30 head and neck microvascular patients, Karimi et al demonstrated the utility of a combination protocol of aspirin and enoxaparin for 5 and 3 days, respectively, for flap survival, with no incidence of flap loss or hematoma. 58 A retrospective study of 137 microvascular reconstruction patients demonstrated that LMWH is an effective standalone antithrombotic, with outcomes comparable to those of HSQ and aspirin studies and a flap survival rate of 97.1%. 59 In a study of 153 microvascular head and neck patients receiving prophylactic doses of dalteparin with or without aspirin, there were six events of hematoma, and this risk was not influenced by the dose of dalteparin or addition of aspirin.…”

Section: Low-molecular-weight Heparinsmentioning

confidence: 98%

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Thromboprophylaxis in Head and Neck Microvascular Reconstruction

Abraham

Badhey

et al. 2018

Craniomaxillofacial Trauma & Reconstruction

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Head and neck patients undergoing microvascular reconstruction are at high risk for thromboembolism. While the prevention of thromboembolism has become an essential aspect of care, within the field of microsurgery, concern for anastomotic complications have hindered the creation of an accepted regimen. The aim of this review was to evaluate the risks and benefits of prophylactic agents for thromboprophylaxis. A literature search was conducted in MEDLINE, Cochrane Library, and PubMed/NCBI databases. Articles discussing thromboprophylaxis in otolaryngology, head and neck surgery, or microvascular reconstruction were considered in the review from the past 30 years. The majority of patients undergoing microvascular surgery have multiple risk factors for thrombus formation. Several consensus guidelines exist for the prophylaxis in patients who are critically ill, undergoing surgery, or with malignancy. Significant evidence supports the routine use of mechanical means, such as early mobilization and pneumatic compression along with subcutaneous heparin. Low-molecular-weight heparin is also frequently utilized, although results are largely divided. Data on aspirin remain equivocal. Studies on microvascular failure and flap loss have demonstrated little to no association with chemoprophylaxis. The evidence for postoperative thromboprophylaxis regimens in patients undergoing head and neck free tissue transfer is variable. Multiple studies have supported the use of unfractionated heparin or low-molecular-weight heparin. There appears to be an expert consensus for the combined use of mechanical prophylactic methods and chemical prophylaxis. Prospective randomized trials are required to validate the most effective combination of chemoprophylaxis agents.

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Section: Resultsmentioning

confidence: 99%

Section: Low-molecular-weight Heparinsmentioning

confidence: 98%

Thromboprophylaxis in Head and Neck Microvascular Reconstruction

Abraham

Badhey

et al. 2018

Craniomaxillofacial Trauma & Reconstruction

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“…15 Since Craven's early observations with regard to aspirin's antiplatelet properties, 16 aspirin has become widely utilized in medicine, from being used for the primary prevention of cardiovascular disease 17 to the application of its antiplatelet properties in protecting newly formed microanastomoses. 1 Although the practice of using aspirin in free tissue transfer has been well described, [1][2][3][4][5][6][7][8] the literature remains lacking of a strong evidence to support or refute its use. 18,19 Moreover, little literature in the plastic and reconstructive field compares the effects of administering a full dose (325 mg) versus the attenuated baby dose (81 mg).…”

Section: Discussionmentioning

confidence: 99%

“…The use of prophylactic aspirin (ASA) following free tissue transfer is well established in the previously published literature. [1][2][3][4][5][6][7][8] Nevertheless, the question with regard to the optimal dosing of aspirin for free tissue transfer remains unanswered. 1,9 Plastic and reconstructive surgeons universally administer prophylactic aspirin to prevent anastomotic thrombosis after free tissue transfer.…”

Section: Introductionmentioning

confidence: 99%

Full versus Baby Dose Aspirin for Antithrombotic Prophylaxis in Free Tissue Transfer: Does Size Matter?

Karamanos

Hazboun

Saad

et al. 2022

Plastic and Reconstructive Surgery - Global Open

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Background: The postoperative prophylactic use of aspirin is a common practice among plastic surgeons after free tissue transfer. The use of baby aspirin (81 mg) has become more popular due to previously published literature in other fields. We hypothesized that a full dose daily aspirin is nonsuperior to a baby dose daily aspirin in preventing arterial thrombosis in free tissue transfer. Methods: All patients undergoing free tissue transfer of the extremities from 2008 to 2020 were retrospectively reviewed. They were divided into two groups based on the postoperative dose of aspirin administered (full versus baby dose). The decision to administer full or baby dose was based on the surgeon’s preference. Primary outcome was revision of the arterial anastomosis. Secondary outcomes included flap complications. Results: A total of 183 patients were identified. Out of those, 78 patients received full dose aspirin postoperatively, whereas 105 received a baby dose of aspirin. Patients who received baby aspirin did not have a higher incidence of returning to the operating room for revision of their arterial anastomosis [7.6% versus 7.7%; adjusted odds ratio, 0.93 (95% confidence interval, 0.28‐3.11); adjusted P, 0.906]. No differences were found between the two groups in complete and partial flap loss, wound dehiscence, or infection. None of the patients experienced any aspirin-related gastrointestinal complications. Conclusions: In patients undergoing free tissue transfer, thrombosis of the arterial anastomosis is rare. Administration of a full dose of aspirin postoperatively was not superior to a baby dose of aspirin in preventing arterial-related complications.

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“…Numerous anti-thrombotic protocols have been described to prevent or treat thrombosis of free flaps. [2][3][4][5] Currently, there is no clear consensus on which anti-thrombotic regime is superior. Multiple studies have proposed anti-thrombotic guidelines, but none have been shown to be superior in preventing thrombosis.…”

Section: Introductionmentioning

confidence: 99%

Multidisciplinary Practice Variations of Anti-Thrombotic Strategies for Free Tissue Transfers

et al. 2021

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Background: Venous thrombosis, the leading cause of free flap failure, may have devastating consequences. Many anti-thrombotic agents and protocols have been described for prophylaxis and treatment of venous thrombosis in free flaps. Methods: National surveys were distributed to microsurgeons (of both Plastics and ENT training) and hematology and thrombosis specialists. Data were collected on routine screening practices, perceived risk factors for flap failure, and pre-, intra-, and post-operative anti-thrombotic strategies. Results: There were 722 surveys distributed with 132 (18%) respondents, consisting of 102 surgeons and 30 hematologists. Sixty-five surgeons and 9 hematologists routinely performed or managed patients with free flaps. The top 3 perceived risk factors for flap failure according to surgeons were medical co-morbidities, past arterial thrombosis, and thrombophilia. Hematologists, however, reported diabetes, smoking, and medical co-morbidities as the most important risk factors. Fifty-four percent of physicians routinely used unfractionated heparin (UFH) or low-molecular-weight heparin (LMWH) as a preoperative agent. Surgeons routinely flushed the flap with heparin (37%), used UFH IV (6%), or both (8%) intra-operatively. Surgeons used a range of post-operative agents such as UFH, LMWH, aspirin, and dextran while hematologists preferred LMWH. There was variation of management strategies if flap thrombosis occurred. Different strategies consisted of changing recipient vessels, UFH IV, flushing the flap, adding post-operative agents, or a combination of strategies. Conclusions: There are diverse practice variations in anti-thrombotic strategies for free tissue transfers and a difference in perceived risk factors for flap failure that may affect patient management.

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Testing a New Anticoagulation Method for Free Flap Reconstruction of Head and Neck Cancers

Cited by 9 publications

References 24 publications

Thromboprophylaxis in Head and Neck Microvascular Reconstruction

Thromboprophylaxis in Head and Neck Microvascular Reconstruction

Full versus Baby Dose Aspirin for Antithrombotic Prophylaxis in Free Tissue Transfer: Does Size Matter?

Multidisciplinary Practice Variations of Anti-Thrombotic Strategies for Free Tissue Transfers

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