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Free Tissue Transfer for Lower Extremity Reconstruction in Thrombophilic Patients: A Comparison of Prophylactic Anticoagulation Protocols
Ersilia L. Anghel, BS, BA, Michael V. DeFazio, MD, Caitlin M. Ward, BA, Karen K. Evans, MD.
Georgetown University, Washington, DC, USA.

PURPOSE:
Subclinical-thrombophilia contributes to delayed thrombotic complications/non-salvageability after free tissue transfer (FTT). Nevertheless, there is no consensus regarding management of perioperative anticoagulation in these patients. We present our experience with lower extremity FTT in thrombophilic patients and compare outcomes for two prophylactic anticoagulation protocols.
METHODS:
Between 2012-2015, 48 patients with subclinical-thrombophilia underwent flaps for non-traumatic, lower extremity reconstruction. Patients were stratified into 2 cohorts based on changes to our protocol for prophylactic anticoagulation in the setting of thrombophilia. Patients received either (1) daily aspirin (325-mg) and subcutaneous heparin (5,000-units every 8 hours) or (2) daily aspirin (325-mg) and fixed-dose subtherapeutic heparin infusion (500-units/hr) followed by conversion to subcutaneous heparin after 5 days. Both protocols were initiated on day 0 and continued for a period of 3 weeks. Demographic data, reconstructive outcomes, and complications were compared.
RESULTS:
Twenty-six patients underwent prophylactic anticoagulation with aspirin/subcutaneous heparin, whereas aspirin/ systemic heparinization was utilized in 22 patients. Differences in overall success, along with incidence of hematoma, and thrombosis are tabulated.
Free Flap Outcomes for Subclinical-thrombophilic patients: Comparison of Anticoagulation Protocols
Total PatientsHematomaThrombosisFlap Success
Systemic Heparin223 (13.6%)4 (18.1%)17 (77.3%)
Subcutaneous Heparin262 (7.69%)3 (11.5%)25 (96.1%)
p value0.500.510.048

CONCLUSION:
Prophylactic anticoagulation with systemic heparin does not significantly reduce thrombotic events following lower extremity FTT in thrombophilic patients and may contribute to higher rates of bleeding complications/flap failure when compared to subcutaneous heparin.


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