Is the use of intraoperative heparin safe? Journal Article


Authors: Chen, C. M.; Ashjian, P.; Disa, J. J.; Cordeiro, P. G.; Pusic, A. L.; Mehrara, B. J.
Article Title: Is the use of intraoperative heparin safe?
Abstract: BACKGROUND: Despite the reliability of microvascular free tissue transfer, flap loss remains a significant concern. To improve outcome, various pharmacologic agents have been used to prevent microvascular thrombosis. The authors review their experience with intraoperative heparin therapy, specifically addressing the risks of hematoma, pedicle thrombosis, and flap loss rate. METHODS: Results from consecutive free flaps performed over a 3-year period were reviewed using a prospectively maintained database. Patients were divided into two groups: group A received a bolus of 3000 units of intraoperative heparin 10 minutes before flap pedicle ligation; group B did not receive intraoperative heparin. Patient demographics, procedure type, diagnosis, adjuvant treatment, and complications were recorded. Outcome variables included microvascular thrombosis, total and partial flap loss, hematoma, seroma, pulmonary embolism, and death. RESULTS: Four hundred seventy patients underwent 505 microvascular free flaps for reconstruction of oncologic defects. Reconstructed areas included head and neck (n = 288), trunk and breast (n = 151), upper extremity (n = 12), and lower extremity (n = 19). Of these, 260 flaps (group A) received an intraoperative heparin bolus, and 245 flaps (group B) received no intraoperative heparin bolus. There were no statistically significant differences in major and minor complications between the two groups (power = 0.85). CONCLUSIONS: Intraoperative systemic heparin use has no statistically significant effect on the incidence of microvascular thrombosis. In addition, administration of a single dose of intraoperative heparin does not increase the rate of hematoma formation or prevent microvascular thrombosis. Thus, critical factors for flap survival are likely independent of the use of intraoperative anticoagulation. ©2008American Society of Plastic Surgeons.
Keywords: adolescent; adult; child; preschool child; school child; aged; aged, 80 and over; child, preschool; middle aged; reconstructive surgical procedures; retrospective studies; major clinical study; plastic surgery; surgical flaps; drug effect; vascularization; retrospective study; lung embolism; postoperative complication; graft failure; intraoperative period; acetylsalicylic acid; thrombosis; anticoagulants; heparin; microcirculation; graft survival; free tissue graft; hematoma; seroma; anticoagulant agent; heparinization
Journal Title: Plastic and Reconstructive Surgery
Volume: 121
Issue: 3
ISSN: 0032-1052
Publisher: Lippincott Williams & Wilkins  
Date Published: 2008-03-01
Start Page: 49e
End Page: 53e
Language: English
DOI: 10.1097/01.prs.0000299267.84139.2a
PUBMED: 18317086
PROVIDER: scopus
DOI/URL:
Notes: --- - "Cited By (since 1996): 14" - "Export Date: 17 November 2011" - "CODEN: PRSUA" - "Source: Scopus"
Altmetric Score
MSK Authors
  1. Joseph Disa
    197 Disa
  2. Andrea Pusic
    278 Pusic
  3. Constance M Chen
    16 Chen
  4. Babak Mehrara
    252 Mehrara
  5. Peter G Cordeiro
    239 Cordeiro