Unfractionated Heparin Administered Every 8 h Outperforms 12 Hourly Administration for Venous Thromboembolism Prophylaxis in Reconstructive Head and Neck Tumor Patients: A 12 Year Retrospective Cohort Study

IF 1.5 3区医学 Q3 SURGERY

Microsurgery Pub Date : 2024-10-21 DOI:10.1002/micr.31248

Jevan Cevik, David P. Newland, Edward Cheong, Omar Shadid, Siyuan Pang, Sakshar Nagpal, Miguel Cabalag, Anand Ramakrishnan

{"title":"Unfractionated Heparin Administered Every 8 h Outperforms 12 Hourly Administration for Venous Thromboembolism Prophylaxis in Reconstructive Head and Neck Tumor Patients: A 12 Year Retrospective Cohort Study","authors":"Jevan Cevik, David P. Newland, Edward Cheong, Omar Shadid, Siyuan Pang, Sakshar Nagpal, Miguel Cabalag, Anand Ramakrishnan","doi":"10.1002/micr.31248","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Background</h3>\n \n <p>Venous thromboembolism (VTE), comprising deep vein thrombosis (DVT) and pulmonary embolism (PE), poses a significant risk of morbidity and mortality in surgical patients, especially those undergoing head and neck cancer surgery with microvascular free flap reconstruction. These patients are at a heightened risk of VTE due to numerous patient and surgical risk factors. VTE chemoprophylaxis guidelines in these patients are limited due to a distinct paucity of research. This study aims to contribute to this scarcity of information, providing guidance for surgeons.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>This retrospective cohort study evaluated the efficacy and safety of subcutaneous unfractionated heparin administered every 8 h versus every 12 h for postoperative VTE prophylaxis in patients undergoing head and neck resections with immediate free flap reconstruction. Data was collected from hospital medical records between January 2010 to December 2021. Patient demographics, operative details, and outcomes, including incidence of VTE and bleeding complications, were analyzed.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>Among 622 patients, those receiving heparin every 8 h (<i>n</i> = 393) demonstrated a significantly lower rate of VTE (0.8%) compared to 12-hourly group (<i>n</i> = 229; 3.9%) (<i>p</i> = 0.006). Additionally, there were no significant differences in the rates of postoperative hematoma between the two groups (9.4% versus 7.9% respectively, <i>p</i> = 0.510).</p>\n </section>\n \n <section>\n \n <h3> Conclusion</h3>\n \n <p>Our study suggests that an increased daily dose of unfractionated heparin every 8 h for VTE chemoprophylaxis is superior to a 12-hourly regimen with comparable bleeding profiles. Further multicentre, prospective studies are needed to validate these results and compare the efficacy and safety of unfractionated heparin with other agents such as low-molecular-weight heparin in this patient group.</p>\n </section>\n </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":null,"pages":null},"PeriodicalIF":1.5000,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Microsurgery","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1002/micr.31248","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"SURGERY","Score":null,"Total":0}

引用次数: 0

Abstract

Background

Venous thromboembolism (VTE), comprising deep vein thrombosis (DVT) and pulmonary embolism (PE), poses a significant risk of morbidity and mortality in surgical patients, especially those undergoing head and neck cancer surgery with microvascular free flap reconstruction. These patients are at a heightened risk of VTE due to numerous patient and surgical risk factors. VTE chemoprophylaxis guidelines in these patients are limited due to a distinct paucity of research. This study aims to contribute to this scarcity of information, providing guidance for surgeons.

Methods

This retrospective cohort study evaluated the efficacy and safety of subcutaneous unfractionated heparin administered every 8 h versus every 12 h for postoperative VTE prophylaxis in patients undergoing head and neck resections with immediate free flap reconstruction. Data was collected from hospital medical records between January 2010 to December 2021. Patient demographics, operative details, and outcomes, including incidence of VTE and bleeding complications, were analyzed.

Results

Among 622 patients, those receiving heparin every 8 h (n = 393) demonstrated a significantly lower rate of VTE (0.8%) compared to 12-hourly group (n = 229; 3.9%) (p = 0.006). Additionally, there were no significant differences in the rates of postoperative hematoma between the two groups (9.4% versus 7.9% respectively, p = 0.510).

Conclusion

Our study suggests that an increased daily dose of unfractionated heparin every 8 h for VTE chemoprophylaxis is superior to a 12-hourly regimen with comparable bleeding profiles. Further multicentre, prospective studies are needed to validate these results and compare the efficacy and safety of unfractionated heparin with other agents such as low-molecular-weight heparin in this patient group.

查看原文本刊更多论文

在头颈部肿瘤整形患者的静脉血栓栓塞预防中，每 8 小时给药一次的非分缩肝素优于每 12 小时给药一次的非分缩肝素：一项为期 12 年的回顾性队列研究。

背景：静脉血栓栓塞症（VTE）包括深静脉血栓形成（DVT）和肺栓塞（PE），对外科手术患者，尤其是接受头颈部癌症手术并进行微血管游离皮瓣重建的患者构成了重大的发病和死亡风险。由于患者和手术风险因素众多，这些患者发生 VTE 的风险更高。由于相关研究明显不足，针对这些患者的 VTE 化学预防指南非常有限。本研究旨在填补这一信息空白，为外科医生提供指导：这项回顾性队列研究评估了在接受头颈部切除术并立即进行游离皮瓣重建的患者术后预防 VTE 时每 8 小时皮下注射一次非分叶肝素与每 12 小时皮下注射一次非分叶肝素的有效性和安全性。数据来自 2010 年 1 月至 2021 年 12 月期间的医院病历。分析了患者的人口统计学特征、手术细节和结果，包括 VTE 和出血并发症的发生率：在622名患者中，每8小时接受肝素治疗的患者（n = 393）的VTE发生率（0.8%）明显低于每12小时接受肝素治疗的患者（n = 229; 3.9%）（p = 0.006）。此外，两组的术后血肿发生率无明显差异（分别为 9.4% 对 7.9%，p = 0.510）：我们的研究表明，在出血情况相当的情况下，每 8 小时增加一次每日剂量的非小数肝素用于 VTE 化学预防优于每 12 小时一次的方案。需要进一步开展多中心、前瞻性研究，以验证这些结果，并比较非分叶肝素与其他药物（如低分子量肝素）在这类患者中的疗效和安全性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Microsurgery 医学-外科

CiteScore

3.80

自引率

19.00%

发文量

128

审稿时长

4-8 weeks

期刊介绍： Microsurgery is an international and interdisciplinary publication of original contributions concerning surgery under microscopic magnification. Microsurgery publishes clinical studies, research papers, invited articles, relevant reviews, and other scholarly works from all related fields including orthopaedic surgery, otolaryngology, pediatric surgery, plastic surgery, urology, and vascular surgery.