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European Archives of Oto-Rhino-Laryngology

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Open Access 01-05-2021 | Hematoma | Head and Neck

Postoperative management of antithrombotic medication in microvascular head and neck reconstruction: a comparative analysis of unfractionated and low-molecular-weight heparin

Authors: Matti Sievert, Miguel Goncalves, Rosalie Tamse, Sarina K. Mueller, Michael Koch, Antoniu-Oreste Gostian, Heinrich Iro, Claudia Scherl

Published in: European Archives of Oto-Rhino-Laryngology | Issue 5/2021

Abstract

Purpose

Free flap reconstruction is a valuable technique to preserve function in oncological head and neck surgery. Postoperative graft thrombosis is a dreaded risk. This study aims to compare low-dose unfractionated heparin (UFH) and low-molecular-weight heparin (LMWH) in perioperative thrombosis prophylaxis.

Methods

This is a retrospective analysis of 266 free flaps performed at our academic center. A comparison was made between 2 patient groups, based on their respective postoperative prophylaxis protocols either with UFH (n = 87) or LMWH (n = 179). Primary endpoints were the frequency of transplant thrombosis and the number of flap failures. Secondary endpoints were the occurrence of peri- and postoperative complications.

Results

The flap survival rate was 96.6% and 93.3% for the groups UFH and LMWH, respectively (P = 0.280). The rate of postoperative bleeding requiring revision was 4.6% and 6.7% for each group, respectively (P = 0.498). We found a hematoma formation in 4.6% and 3.9% (P = 0.792).

Conclusion

The free-flap survival rate using low-dose UFH seems to be equivalent to LMWH regimens without compromising the postoperative outcome. Consequently, for risk-adapted thrombosis prophylaxis, either LMWH or UFH can be administrated.

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Title: Postoperative management of antithrombotic medication in microvascular head and neck reconstruction: a comparative analysis of unfractionated and low-molecular-weight heparin
Authors: Matti Sievert
Miguel Goncalves
Rosalie Tamse
Sarina K. Mueller
Michael Koch
Antoniu-Oreste Gostian
Heinrich Iro
Claudia Scherl
Publication date: 01-05-2021
Publisher: Springer Berlin Heidelberg
Keywords: Hematoma
Thrombosis
Heparin
Published in: European Archives of Oto-Rhino-Laryngology / Issue 5/2021
Print ISSN: 0937-4477
Electronic ISSN: 1434-4726
DOI: https://doi.org/10.1007/s00405-020-06219-w

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Postoperative management of antithrombotic medication in microvascular head and neck reconstruction: a comparative analysis of unfractionated and low-molecular-weight heparin

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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