The effect of postoperative anticoagulation on microvascular thrombosis Journal Article


Authors: Ashjian, P.; Chen, C. M.; Pusic, A.; Disa, J. J.; Cordeiro, P. G.; Mehrara, B. J.
Article Title: The effect of postoperative anticoagulation on microvascular thrombosis
Abstract: BACKGROUND: Numerous protocols exist to prevent thrombosis after free-tissue transfer. Many surgeons advocate using aspirin or other antiplatelet agents, but little objective evidence supports this practice. This study evaluates the rate of microvascular thrombosis in patients undergoing free-tissue transfer treated with or without antiplatelet agents. METHODS: All consecutive free flaps from 2002-2005 at a single center were reviewed using a prospectively maintained database. Patients were in 2 groups based on postoperative anticoagulation administration. In group 1, 325 mg of aspirin was administered daily for 5 days postoperatively. In group 2, patients were treated with 5000 units of low-molecular-weight heparin (LMWH) per day until ambulating. Patient demographics, procedure type, diagnosis, adjuvant treatment, and procedure type were recorded. Outcome variables included microvascular thrombosis, partial or total flap loss, hematoma, bleeding, deep venous thrombosis (DVT), pulmonary embolism, and death. RESULTS: Four hundred seventy patients underwent 505 microvascular free flaps to reconstruct oncologic defects. Two hundred sixty flaps (group A) received postoperative aspirin therapy; 245 flaps (group B) received LMWH therapy. Both groups were statistically similar in their composition. No statistically significant difference was noted between the 2 groups when comparing outcome variables including microvascular thrombosis, partial or total flap loss, hematoma, bleeding, DVT, pulmonary embolism, and death. CONCLUSIONS: Postoperative anticoagulation choice has no statistically significant effect on the incidence of free flap complications, including bleeding, thromboembolism, and flap loss. We conclude that aspirin or LMWH therapy demonstrates equivalent outcomes when used as single-agent postoperative anticoagulation in oncologic free flap reconstruction. © 2007 Lippincott Williams & Wilkins, Inc.
Keywords: adolescent; adult; child; aged; aged, 80 and over; child, preschool; middle aged; major clinical study; microvascular surgery; surgical flaps; postoperative care; microsurgery; graft necrosis; lung embolism; graft failure; acetylsalicylic acid; thrombosis; anti-inflammatory agents, non-steroidal; anticoagulants; postoperative infection; anticoagulation; postoperative hemorrhage; free tissue graft; hematoma; seroma; wound healing impairment; postoperative; low molecular weight heparin; mobilization; heparin, low-molecular-weight; venous thrombosis; aspirin; free flaps; outcome variable
Journal Title: Annals of Plastic Surgery
Volume: 59
Issue: 1
ISSN: 0148-7043
Publisher: Lippincott Williams & Wilkins  
Date Published: 2007-07-01
Start Page: 36
End Page: 39
Language: English
DOI: 10.1097/01.sap.0000264837.15110.2f
PUBMED: 17589257
PROVIDER: scopus
DOI/URL:
Notes: --- - "Cited By (since 1996): 23" - "Export Date: 17 November 2011" - "CODEN: APCSD" - "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