Article
Use and Advantages Of An Anticoagulation Therapy Based In Non-Fractioned Heparin In A Case Series Of Extremity Reconstruction With Free Flaps
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Authors
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Constanza L. Moreno-Serrano
- Fundacion Santa Fe De Bogotá University Hospital, Universidad de los Andes, Bogotá, Colombia
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María A. Gómez
- Universidad de los Andes, Bogotá, Colombia
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Julio Bermúdez
- Fundacion Santa Fe De Bogotá University Hospital, Universidad de los Andes, Bogotá, Colombia
| Published: | February 6, 2020 |
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Outline
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Objectives/Interrogation: Local thrombosis is one of the most frequent causes of failure of flaps and one of the main causes of total or partial loss. Surgery causes hemostatic changes which trigger the coagulation cascade, leading to a hypercoagulable state characterized by increased platelet activity, decreased levels of endogenous anticoagulation factors and diminished fibrinolysis all leading to a pro-thrombotic state.
Based on the forth mentioned and given that there is no consensus in the literature on how to safely use anticoagulation in microvascular surgery, it was evident that there was a need to ensure that properly made anastomosis would not fail by a physiological problem preventable through the use of thromboprophylaxis.
The objective is to evaluate how the implementation of a non-fractioned heparin based protocol directed toward preventing small vessel thrombosis without increasing the risk of hematoma formation.
Methods: All patients in which a free flap was done to reconstruct an extremity since 2005 were identified and included in the database. Information regarding the type of flap, age, risk factors, indication, time of ischemia, the anticoagulation protocol used, and complications was taken.
The cases were divided between non-fractioned heparin scheme used and others anticoagulation systems, and we reported the differences in complications between the groups.
Results and Conclusions: After evaluating the medical charts we found that we could intervene ensuring prevention in the formation of thrombi in a well-done anastomosis without increasing the risk of bleeding by implementing the presented protocol.
Most of the patients involved in this protocol did not have thrombosis or bleeding complications. Patients who required surgery to revise the anastomosis were studied independently, and factors that could have favored complications were identified. There were no cases of thrombocytopenia caused by heparin.
By establishing this protocol we did not find the formation of hematomas and thrombus. This led to a decrease in the ratio of total and partial loss of free flaps at our center. As a result, we recommend that in centers where reconstruction with the microvascular technique is performed, an anticoagulation protocol should be established.
