Comparison of the hepatotoxicity of low-molecular-weight versus unfractionated heparin for anticoagulation therapy after digital replantation

Purpose: Unfractionated heparin (UFH) is more commonly used as an anticoagulant after digital replantation than low-molecular-weight heparin (LMWH). We compared the success and complication rates of these two anticoagulants, since only a few studies have made this comparison directly. Methods: Forty-four patients who underwent digital replantation for complete or incomplete digital amputation in the past 7 years at a single institution were included. The patients were divided into LMWH and UFH groups according to the anticoagulant administered. The success rates for each group were obtained, and the postoperative serum aspartate aminotransferase (AST) and alanine transaminase (ALT) levels were analyzed to compare the complication rates.Results: All patients, except one, had successful recovery of circulation after replantation, and the success rate did not show a statistically significant difference between the two groups. The statistical analysis showed that the proportion of patients with abnormal serum AST or ALT levels in the LMWH group was significantly lower than that in the UFH group.Conclusion: Although there was no significant difference in the success rate between the two groups, the risk of hepatotoxicity was significantly lower in the LMWH group than in the UFH group. Considering the advantages of LMWH, its extensive use is highly recommended for anticoagulation therapy in patients after digital replantation.