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Updated: May 18, 2026
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Published on: November 8, 2019
Effect of postoperative aspirin on outcomes in microvascular free tissue transfer surgery
Jessyka G Lighthall1, Rachel Cain, Tamer A Ghanem
1Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, Oregon 29239, USA. lighthal@ohsu.edu
Objective:
Examine if outcomes and complication rates for free flaps vary when postoperative aspirin is used as pharmacologic thromboprophylaxis compared with no anticoagulation.
Study Design:
Case series with chart review. Setting Oregon Health and Science University, an academic medical center.
Subjects And Methods:
A case series with chart review was performed using a prospectively maintained microvascular reconstructive database to identify cases of free tissue transfer between February 2006 and April 2010. Outcome variables included complications, flap failure, reexploration, and salvage. Chi-square analysis was performed to identify differences based on type of postoperative antithrombotic therapy.
Results:
A total of 390 consecutive free tissue transfer procedures were performed; 184 received no postoperative thromboprophylaxis, 142 received aspirin, 48 received low molecular weight heparin or a combination of agents, and 16 received a heparin drip. The overall complication rate was 38%, with significantly more complications in the aspirin group compared with no prophylaxis (P = .002). There was no significant difference in bleeding complications (P = .192) or flap failure (P = .839) between aspirin and no anticoagulation. There were more postoperative revisions in the aspirin group (P = .039).
Conclusion:
Postoperative thromboprophylaxis with aspirin after microvascular free tissue transfer does not provide an improvement in free flap survival and may be associated with a higher complication rate. Prospective, randomized studies are required to elucidate the role of postoperative pharmacotherapy for prophylaxis against microvascular thrombosis.
