Pharmacologic optimization of microsurgery in the new millennium

After studying this article, the participant should be able to: 1. Understand the mechanisms by which the three most common antithrombotic agents work. 2. Be familiar with accepted dosing levels for the three agents. 3. Understand the rationale for their use and formulate an algorithmic approach to microvascular thrombosis. Microsurgical anastomoses are largely technically dependent; however, there exists a finite rate of failure, with often devastating consequences. Pharmacologic prophylaxis and intervention are used extensively in microsurgical cases, yet a unified algorithm does not exist among the various basic science and clinical studies in the literature. This results in a confusing and nonstandardized practice based on anecdotal experiences. The purpose of this article is to review the literature on this topic and synthesize a practical clinical management algorithm for pharmacologic therapy in microsurgery.