PMID- 35272089
OWN - NLM
STAT- MEDLINE
DCOM- 20221004
LR  - 20221113
IS  - 2468-7855 (Electronic)
IS  - 2468-7855 (Linking)
VI  - 123
IP  - 5
DP  - 2022 Oct
TI  - Aspirin, heparin and ischemia time in microvascular free flap surgery - their 
      influence and an optimal anticoagulation protocol.
PG  - e556-e562
LID - S2468-7855(22)00049-0 [pii]
LID - 10.1016/j.jormas.2022.03.001 [doi]
AB  - BACKGROUND: Microvascular surgery has become a standardized technique for 
      reconstruction of large tissue defects in Head and Neck Reconstructive Surgery. 
      However, the main dreaded complications are thrombosis of blood vessels or major 
      bleeding after surgery. Several different anticoagulation protocols have been 
      established in the last decades to overcome these problems with varying degrees 
      of success. METHODS: Over a period of six years, a standardized anticoagulation 
      protocol including acetylsalicylic acid (ASA) and unfractionated heparin (UFH) 
      for direct intraoperative and postoperative administration was established, 
      optimized and compared to a previously used non-standardized protocol. A total of 
      178 flap surgeries were included in the development and optimization process of 
      the protocol. RESULTS: ASA significantly increased the risk of complications when 
      used for longer than 72 h (OR = 2.52; p = 0.002; 95% CI 1.39-4.59). 
      Administration of UFH reduced flap loss (bolus: OR 0.68; p = 0.47; 95% CI 
      0.24-1.93; continuous UFH administration: OR = 0.61; p = 0.33; 95% CI 0.22-1.66), 
      however doses greater than 500 IU/ h of UFH as continuous infusion increased the 
      risk of complications. Reduction in ischemia time had no effect on the occurrence 
      of complications. CONCLUSION: Anticoagulation regimes in microvascular surgery 
      can influence the postoperative complication rate. The optimal protocol should 
      consist of a combination of ASA and UFH for the intraoperative and direct 
      postoperative phase. Prolonged administration of ASA as well as doses >500 IU/ 
      h of UFH are to be avoided due to the increased complication rate.
CI  - Copyright (c) 2022 Elsevier Masson SAS. All rights reserved.
FAU - Rothweiler, Rene
AU  - Rothweiler R
AD  - Department of Oral and Maxillofacial Surgery, Faculty of Medicine, University of 
      Freiburg, Freiburg, Germany.
FAU - Gerlach, Vanessa
AU  - Gerlach V
AD  - Department of Oral and Maxillofacial Surgery, Faculty of Medicine, University of 
      Freiburg, Freiburg, Germany.
FAU - Voss, Pit
AU  - Voss P
AD  - Department of Oral and Maxillofacial Surgery, Faculty of Medicine, University of 
      Freiburg, Freiburg, Germany.
FAU - Poxleitner, Philipp
AU  - Poxleitner P
AD  - Department of Oral and Maxillofacial Surgery, Faculty of Medicine, University of 
      Freiburg, Freiburg, Germany.
FAU - Ermer, Michael
AU  - Ermer M
AD  - Department of Oral and Maxillofacial Surgery, Faculty of Medicine, University of 
      Freiburg, Freiburg, Germany.
FAU - Gross, Christian
AU  - Gross C
AD  - Department of Oral and Maxillofacial Surgery, Faculty of Medicine, University of 
      Freiburg, Freiburg, Germany.
FAU - Schwer, Christian
AU  - Schwer C
AD  - Department of Anesthesiology and Critical Care, Faculty of Medicine, University 
      of Freiburg, Freiburg, Germany.
FAU - Vach, Kirstin
AU  - Vach K
AD  - Institute of Medical Biometry and Statistics, Faculty of Medicine, University of 
      Freiburg, Freiburg, Germany.
FAU - Kalbhenn, Johannes
AU  - Kalbhenn J
AD  - Department of Anesthesiology and Critical Care, Faculty of Medicine, University 
      of Freiburg, Freiburg, Germany.
FAU - Metzger, Marc
AU  - Metzger M
AD  - Department of Oral and Maxillofacial Surgery, Faculty of Medicine, University of 
      Freiburg, Freiburg, Germany.
LA  - eng
PT  - Journal Article
DEP - 20220307
PL  - France
TA  - J Stomatol Oral Maxillofac Surg
JT  - Journal of stomatology, oral and maxillofacial surgery
JID - 101701089
RN  - 0 (Anticoagulants)
RN  - 9005-49-6 (Heparin)
RN  - R16CO5Y76E (Aspirin)
SB  - IM
MH  - Anticoagulants/adverse effects
MH  - Aspirin/adverse effects
MH  - *Free Tissue Flaps
MH  - *Heparin/adverse effects
MH  - Humans
MH  - Ischemia/epidemiology/surgery
MH  - Postoperative Complications/epidemiology/etiology/prevention & control
OTO - NOTNLM
OT  - Acetylsalicylic acid
OT  - Anticoagulation protocols
OT  - Flap loss
OT  - Microvascular surgery
OT  - Unfractionated heparin
COIS- Declarations of interest NONE.
EDAT- 2022/03/11 06:00
MHDA- 2022/10/05 06:00
CRDT- 2022/03/10 20:13
PHST- 2022/02/12 00:00 [received]
PHST- 2022/03/02 00:00 [accepted]
PHST- 2022/03/11 06:00 [pubmed]
PHST- 2022/10/05 06:00 [medline]
PHST- 2022/03/10 20:13 [entrez]
AID - S2468-7855(22)00049-0 [pii]
AID - 10.1016/j.jormas.2022.03.001 [doi]
PST - ppublish
SO  - J Stomatol Oral Maxillofac Surg. 2022 Oct;123(5):e556-e562. doi: 
      10.1016/j.jormas.2022.03.001. Epub 2022 Mar 7.