Plastic Surgery Research Council
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PSRC 60th Annual Meeting
Program and Abstracts

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Systematic Review And Meta-analysis Comparing The Use Of Heparin Vs No-heparin Protocol In Patients Undergoing Breast Reconstruction
Anne Tong Jia Wei, MBBS, Andrew McKean, BSc, Keli Kolegraff, MD, Justin M. Sacks, MD.
Johns Hopkins Hospital, Baltimore, MD, USA.

PURPOSE: In breast cancer patients undergoing breast reconstructive procedure, it is uncertain whether the use of heparin confers an increased protective effect on the risk of venous thromboembolism without significantly increasing risk of bleeding-related complications (hematoma, transfusions). Prophylactic or postoperative LMWH protocols have previously demonstrated reduced risk of VTE in this patient population. We conducted a comprehensive literature review to determine the risk/benefit profile of heparin use in preventing venous thromboembolism versus the risk of hematoma formation in this patient population.
METHODS: A comprehensive search in MEDLINE, Embase and Scopus was conducted using the terms “anticoagulant“, ‘mammaplasty‘ and “breast reconstruction“. All referenced citations were also screened for use. Inclusion criteria were patients with breast reconstruction that received chemoprophylaxis compared to patients without receipt of chemoprophylaxis. Our study analysis aims to compare outcome parameters defining event rates of venous thromboembolism and hematoma in either comparison groups. Meta-analysis was performed with RevMan 5 software.
RESULTS: We found 5 studies that met our inclusion criteria, comprising of 2643 patients (N=1333 heparin vs n=1310 no-heparin). We conducted a meta-analysis of studies that reported hematoma event rates within 60 days and found that the use of a heparin protocol is not associated with a statistically significant increase in hematoma rates [Figure 1 (OR 1.15, 95% CI: 0.7-1.9, P=0.58)]. When analyzed by total venous thromboembolic events (1866 patients), overall rates of VTE is decreased by 7 times in the cohort that received a heparin protocol [Figure 2(OR 7.01, 95% CI: 2.55 - 19.27, p=0.0002)].
CONCLUSION: Our meta-analysis observed that the use of heparin protocol is not associated with a statistically significant increase in hematoma events, however it appears to significantly decrease the odds of VTE risks. The lack of prospective clinical trials comparative analysis comparing the timing and dosage of use in this patient population warrants further such studies.


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