PMID- 32710177
OWN - NLM
STAT- MEDLINE
DCOM- 20210423
LR  - 20210731
IS  - 1434-4726 (Electronic)
IS  - 0937-4477 (Print)
IS  - 0937-4477 (Linking)
VI  - 278
IP  - 5
DP  - 2021 May
TI  - Postoperative management of antithrombotic medication in microvascular head and 
      neck reconstruction: a comparative analysis of unfractionated and 
      low-molecular-weight heparin.
PG  - 1567-1575
LID - 10.1007/s00405-020-06219-w [doi]
AB  - PURPOSE: Free flap reconstruction is a valuable technique to preserve function in 
      oncological head and neck surgery. Postoperative graft thrombosis is a dreaded 
      risk. This study aims to compare low-dose unfractionated heparin (UFH) and 
      low-molecular-weight heparin (LMWH) in perioperative thrombosis prophylaxis. 
      METHODS: This is a retrospective analysis of 266 free flaps performed at our 
      academic center. A comparison was made between 2 patient groups, based on their 
      respective postoperative prophylaxis protocols either with UFH (n = 87) or LMWH 
      (n = 179). Primary endpoints were the frequency of transplant thrombosis and the 
      number of flap failures. Secondary endpoints were the occurrence of peri- and 
      postoperative complications. RESULTS: The flap survival rate was 96.6% and 93.3% 
      for the groups UFH and LMWH, respectively (P = 0.280). The rate of postoperative 
      bleeding requiring revision was 4.6% and 6.7% for each group, respectively 
      (P = 0.498). We found a hematoma formation in 4.6% and 3.9% (P = 0.792). 
      CONCLUSION: The free-flap survival rate using low-dose UFH seems to be equivalent 
      to LMWH regimens without compromising the postoperative outcome. Consequently, 
      for risk-adapted thrombosis prophylaxis, either LMWH or UFH can be administrated.
FAU - Sievert, Matti
AU  - Sievert M
AUID- ORCID: 0000-0003-0741-4049
AD  - Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich Alexander 
      University of Erlangen-Nuremberg, Waldstrasse 1, 91054, Erlangen, Germany. 
      matti.sievert@uk-erlangen.de.
FAU - Goncalves, Miguel
AU  - Goncalves M
AD  - Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich Alexander 
      University of Erlangen-Nuremberg, Waldstrasse 1, 91054, Erlangen, Germany.
FAU - Tamse, Rosalie
AU  - Tamse R
AD  - Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich Alexander 
      University of Erlangen-Nuremberg, Waldstrasse 1, 91054, Erlangen, Germany.
FAU - Mueller, Sarina K
AU  - Mueller SK
AD  - Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich Alexander 
      University of Erlangen-Nuremberg, Waldstrasse 1, 91054, Erlangen, Germany.
FAU - Koch, Michael
AU  - Koch M
AD  - Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich Alexander 
      University of Erlangen-Nuremberg, Waldstrasse 1, 91054, Erlangen, Germany.
FAU - Gostian, Antoniu-Oreste
AU  - Gostian AO
AD  - Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich Alexander 
      University of Erlangen-Nuremberg, Waldstrasse 1, 91054, Erlangen, Germany.
FAU - Iro, Heinrich
AU  - Iro H
AD  - Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich Alexander 
      University of Erlangen-Nuremberg, Waldstrasse 1, 91054, Erlangen, Germany.
FAU - Scherl, Claudia
AU  - Scherl C
AD  - Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich Alexander 
      University of Erlangen-Nuremberg, Waldstrasse 1, 91054, Erlangen, Germany.
LA  - eng
PT  - Journal Article
DEP - 20200724
PL  - Germany
TA  - Eur Arch Otorhinolaryngol
JT  - European archives of oto-rhino-laryngology : official journal of the European 
      Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the 
      German Society for Oto-Rhino-Laryngology - Head and Neck Surgery
JID - 9002937
RN  - 0 (Anticoagulants)
RN  - 0 (Fibrinolytic Agents)
RN  - 0 (Heparin, Low-Molecular-Weight)
RN  - 9005-49-6 (Heparin)
SB  - IM
MH  - Anticoagulants/therapeutic use
MH  - *Fibrinolytic Agents/therapeutic use
MH  - Heparin
MH  - *Heparin, Low-Molecular-Weight/therapeutic use
MH  - Humans
MH  - Retrospective Studies
PMC - PMC8057982
OTO - NOTNLM
OT  - Antithrombotic agent
OT  - Flap failure
OT  - Free-flap reconstruction
OT  - Head and neck
OT  - Thrombosis
COIS- None of the authors have a personal conflict of interest to declare.
EDAT- 2020/07/28 06:00
MHDA- 2021/04/24 06:00
PMCR- 2020/07/24
CRDT- 2020/07/26 06:00
PHST- 2020/05/28 00:00 [received]
PHST- 2020/07/15 00:00 [accepted]
PHST- 2020/07/28 06:00 [pubmed]
PHST- 2021/04/24 06:00 [medline]
PHST- 2020/07/26 06:00 [entrez]
PHST- 2020/07/24 00:00 [pmc-release]
AID - 10.1007/s00405-020-06219-w [pii]
AID - 6219 [pii]
AID - 10.1007/s00405-020-06219-w [doi]
PST - ppublish
SO  - Eur Arch Otorhinolaryngol. 2021 May;278(5):1567-1575. doi: 
      10.1007/s00405-020-06219-w. Epub 2020 Jul 24.