Postoperative anticoagulation in patients with microvascular reconstruction - a systematic review.

IF 1.7 Q3 DENTISTRY, ORAL SURGERY & MEDICINE

Oral and Maxillofacial Surgery-Heidelberg Pub Date : 2025-02-12 DOI:10.1007/s10006-025-01351-5

Moritz Bleymehl, Julius Moratin, Maximilian Smielowski, Gregor Schnug, Thomas Rückschloß, Cornelius Busch, Michael Engel, Jürgen Hoffmann, Oliver Ristow

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引用次数: 0

Abstract

Objective: To assess the currently applied regimens of antithrombotic therapy after microvascular reconstruction.

Methods: A systematic literature review was performed using the MEDLINE/PubMed Database for work published until September 2022. Data synthesis and risk of bias were reported in accordance with NIH Study Quality Assessment Tools guidelines.

Results: 204 articles were found including the keywords either in the abstract or in the title. After screening their abstracts and titles, 41 articles were identified as suitable and the full texts were retrieved. 23 studies were included in this review. No gold standard could be shown; on the contrary, the applied antithrombotic regimens varied widely. A broad consensus could be obtained that Dextran should no longer be used after an increased complication rate was proven. The most commonly used agents are unfractionated (UFH) as well as low molecular weight (LMWH) heparin and acetylsalecylic acid (ASA), although the literature results are partly contradictory.

Conclusions: A consensus could be found that it is useful to perform thromboprophylaxis when the patient is immobilized, but there is no evidence for a survival advantage of the flap by chemical prophylaxis. On the contrary, it has been shown that there is an increased rate of bleeding complications and flap loss combined with the simultaneous use of multiple chemical anticoagulants. In conclusion the generalized use of anticoagulation is explained less by microvascular grafting than by general medical risk factors. Thus, large prospective RCTs will be needed to establish a gold standard therapeutic regimen.

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微血管重建患者术后抗凝治疗的系统综述。

目的：评价微血管重建后抗血栓治疗的常用方案。方法：使用MEDLINE/PubMed数据库对截至2022年9月发表的作品进行系统的文献综述。根据NIH研究质量评估工具指南报告数据综合和偏倚风险。结果：检索到包含摘要和标题关键词的文献204篇。筛选摘要和标题后，筛选出41篇文章，检索全文。本综述纳入了23项研究。没有黄金标准；相反，应用的抗血栓治疗方案差异很大。在证实并发症发生率增加后，可以获得葡聚糖不应再使用的广泛共识。最常用的药物是未分级（UFH）以及低分子量（LMWH）肝素和乙酰氨基环酸（ASA），尽管文献结果部分矛盾。结论：可以发现一个共识，即在患者固定时进行血栓预防是有用的，但没有证据表明通过化学预防皮瓣的生存优势。相反，有研究表明，同时使用多种化学抗凝剂会增加出血并发症和皮瓣丢失的发生率。综上所述，微血管移植对抗凝的广泛应用的解释要小于一般的医疗危险因素。因此，需要大量的前瞻性随机对照试验来建立黄金标准治疗方案。

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来源期刊

Oral and Maxillofacial Surgery-Heidelberg DENTISTRY, ORAL SURGERY & MEDICINE-

CiteScore

3.20

自引率

5.60%

发文量

118

期刊介绍： Oral & Maxillofacial Surgery founded as Mund-, Kiefer- und Gesichtschirurgie is a peer-reviewed online journal. It is designed for clinicians as well as researchers.The quarterly journal offers comprehensive coverage of new techniques, important developments and innovative ideas in oral and maxillofacial surgery and interdisciplinary aspects of cranial, facial and oral diseases and their management. The journal publishes papers of the highest scientific merit and widest possible scope on work in oral and maxillofacial surgery as well as supporting specialties. Practice-oriented articles help improve the methods used in oral and maxillofacial surgery.Every aspect of oral and maxillofacial surgery is fully covered through a range of invited review articles, clinical and research articles, technical notes, abstracts, and case reports. Specific topics are: aesthetic facial surgery, clinical pathology, computer-assisted surgery, congenital and craniofacial deformities, dentoalveolar surgery, head and neck oncology, implant dentistry, oral medicine, orthognathic surgery, reconstructive surgery, skull base surgery, TMJ and trauma.Time-limited reviewing and electronic processing allow to publish articles as fast as possible. Accepted articles are rapidly accessible online.Clinical studies submitted for publication have to include a declaration that they have been approved by an ethical committee according to the World Medical Association Declaration of Helsinki 1964 (last amendment during the 52nd World Medical Association General Assembly, Edinburgh, Scotland, October 2000). Experimental animal studies have to be carried out according to the principles of laboratory animal care (NIH publication No 86-23, revised 1985).