The Efficacy of Postoperative Antithrombotics in Free Flap Surgery

Lee, Kyeong‐Tae; Mun, Goo‐Hyun

doi:10.1097/prs.0000000000001100

Cited by 67 publications

(64 citation statements)

References 17 publications

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“…The current study highlights the use of multiple antithrombotics as a potential risk factor for haematoma formation related to both flap congestion and pedicle thrombosis. The results are further well supported by a recent review and meta-analysis by Lee and Mun [13] that clearly demonstrates an increased risk of haematoma formation in free flap surgery by different types of antithrombotics (aspirin, heparin, or LMWH and dextran) without improved flap outcome for any of the agents. The authors discuss the fact ''that haematoma around the flap itself can manifest as a portent of pedicle thrombosis and flap congestion, a correlation between flap haematoma and flap failure can affect the results and should also be evaluated; however it could not be analysed because of an insufficient number of studies investigating the relationship'' [13, p. 1135].…”

Section: Discussionsupporting

confidence: 69%

“…The results of the current study have eliminated the routine use of dextran prophylaxis in microsurgical reconstruction at our institution. Since flap outcome is mainly dependent on technical factors, we suggest that antithrombotic treatment shall mainly be used to prevent deep venous thrombosis and not to improve the flap outcome, which is further supported by a recent meta-analysis [13]. A review of the literature, together with comparison of antithrombotic prophylaxis at different microsurgical centres, clearly shows that further randomised Table 5.…”

Section: Discussionmentioning

confidence: 76%

“…Several animal studies have demonstrated favourable effects on free flap outcome by these different agents, whereas clinical studies have failed to reproduce these results in humans [4,[6][7][8][9][10][11][12]. Although most agents are used to prevent systemic thrombosis today, many centres still use different agents to improve the flap outcome [4,13]. Since antithrombotic agents could have a detrimental role by causing haematomas, that may stretch or compress the pedicle, we hypothesised that haematoma formation may be a risk factor related to the use of multiple antithrombotic agents in modern free flap surgery.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Breast free flap complications related to haematoma formation – do the risks of multiple antithrombotics outweigh the benefits today?

Halle

Skogh

Friberg

et al. 2016

Journal of Plastic Surgery and Hand Surgery

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Background Free flap reconstruction is today a common operation for many breast cancer patients, but local protocols for microsurgery still predict the use of antithrombotic agents. Reduced operation times and complication rates together with faster mobilisation, after introduction of perforator flaps, call for less comprehensive antithrombotic regimens. It was hypothesised that multiple antithrombotics was a risk factor for bleeding-related flap complications. Methods A retrospective cohort study was conducted to study the association between reoperation for haematoma and flap-related complications after free flap breast reconstruction. A combination of heparin, low-molecular-weight heparin and dextran were used as antithrombotics. A sub-analysis was performed to compare non-dextran to dextran treated patients. Results One hundred and thirty-nine patients were identified, reconstructed with 150 consecutive perforator free flaps to the breast. Reoperation for breast haematoma (13%) was associated with concomitant re-operation for venous congestion (8.6%) (p < 0.001), but also for flap thrombosis (2.9%) (p = 0.007), highlighting haematoma as a risk factor for flap-related complications. An increased rate of haematoma re-operations of the breast was noted among the flap-related complications in the dextran (n = 79), compared to the non-dextran group (p = 0.011). Conclusion The current study highlights the use of multiple antithrombotics as a risk factor for haematoma reoperation. Liberal use of drains and evacuation of breast haematomas are, therefore, indicated together with limitation of antithrombotic agents. The highly variable use of antithrombotic agents worldwide call for evidence-based guidelines in standardised free flap breast reconstruction.

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Section: Discussionsupporting

confidence: 69%

Section: Discussionmentioning

confidence: 76%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Breast free flap complications related to haematoma formation – do the risks of multiple antithrombotics outweigh the benefits today?

Halle

Skogh

Friberg

et al. 2016

Journal of Plastic Surgery and Hand Surgery

View full text Add to dashboard Cite

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“…The role of anticoagulants is controversial, and includes aspirin, low-molecular-weight dextran, and subcutaneous heparin [22,23]. Despite the increased risks of hematoma related to all the antithrombotic medicaments (most of all the aspirin) and the absence of general consensus on their efficacy in failure prevention, the morbidity represented by the loss of a free flap leaded us to systematically treat our patients with a daily dose of low-weight subcutaneous heparin and this protocol, that is also used for deep vein thrombosis prevention, appeared to be reliable [21,22]. There are still no evidence-based guidelines for the prevention of microvascular thrombosis in the head and neck [21,22].…”

Section: Discussionmentioning

confidence: 99%

The effect of admission to intensive care unit on outcomes and complication rates after head and neck reconstruction

Carta

Figus

Chuchueva

et al. 2018

Opuholi golovy i šei

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The study objectiveis to evaluate the utilisation and effectiveness of intensive care unit (ICU) in the postoperative period as to its potential benefits to the head and neck reconstruction services.Materials and methods. This is a retrospective study on 143 consecutive patients who underwent 144 major head and neck microvascular reconstructive procedures performed by a single surgeon, that focused on perioperative management and on the relation between admission to ICU and complications/outcomes.Results.Thirty-four (23.6 %) patients were admitted to ICU during the early postoperative period. Admission to ICU was not associated with lower incidence of complications compared to direct admission to the Head and Neck ward: 29.4 % vs 27.3 % (p = 0.807709).Conclusion.Routinely early postoperative admission to ICU seems not to improve outcomes and/or reduce complications, and, as a consequence, ICU admission should be restricted to selected patients only.

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“…17,[33][34][35][36][37] Because flap failure can be caused by thrombosis at the anastomotic site, many patients are placed on antithrombotic medication in the perioperative period, and this has been associated with an increased incidence of postoperative hematoma. 38…”

Section: Free Tissue Transfermentioning

confidence: 99%

AHNS Series: Do you know your guidelines? Perioperative antithrombotic management in head and neck surgery

2017

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Head and neck surgeons are commonly faced with surgical patients who have underlying medical problems requiring antithrombotic therapy. It is difficult to achieve a balance between minimizing the risk of thromboembolism and hemorrhage in the perioperative period. Data from randomized, controlled trials are limited, and procedurespecific bleed rates are also difficult to pinpoint. The decision is made more difficult when patients with moderate-to-high risk for thromboembolic events undergo procedures that are high risk for bleeding. This is true for many head and neck oncologic surgeries. Furthermore, although elective procedures may be delayed for optimization of antithrombotic medication, emergent procedures cannot. Head and neck surgery often represents the most challenging of all these circumstances, given the potential risk of airway compromise from bleeding after head and neck surgery. K E Y W O R D Santicoagulants, antithrombotics, guidelines, head and neck cancer, perioperative | I NT ROD UCTI ONOpinions can differ among medical specialists, surgeons, and anesthesiologists regarding perioperative antithrombotic management. The purpose of this article is to review contemporary guidelines, based on the available literature, for management of antithrombotic medications in the perioperative period specific to head and neck oncologic surgery. Although general guidelines are helpful, it should be stressed that clear lines of communication among providers are essential to achieve a "right balance," especially in cases that do not fit neatly within existing guidelines.

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The Efficacy of Postoperative Antithrombotics in Free Flap Surgery

Abstract: There is little evidence suggesting that the use of antithrombotics reduces the risk of thrombosis and total flap failure. Although randomized controlled studies would be required, the risks of routine administration of antithrombotics may outweigh the benefits.

Cited by 67 publications

References 17 publications

Breast free flap complications related to haematoma formation – do the risks of multiple antithrombotics outweigh the benefits today?

Breast free flap complications related to haematoma formation – do the risks of multiple antithrombotics outweigh the benefits today?

The effect of admission to intensive care unit on outcomes and complication rates after head and neck reconstruction

AHNS Series: Do you know your guidelines? Perioperative antithrombotic management in head and neck surgery

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