Does Anticoagulation Improve Flap Outcomes in Hypercoagulable Patients? A Systematic Review

Area of Science:

• Microsurgery
• Vascular Surgery
• Hematology

Background:

• Hypercoagulable patients present challenges in free tissue transfer due to thrombophilia risks.
• Free flap loss is a potential catastrophic outcome in these patients.
• Optimizing management strategies is crucial for successful reconstructive surgery.

Purpose of the Study:

• To systematically review literature on free tissue transfer outcomes in hypercoagulable patients.
• To develop evidence-based recommendations for managing thrombophilic patients undergoing free flap surgery.
• To assess the efficacy and risks of anticoagulation regimens in this population.

Main Methods:

• Systematic review of PubMed, EBSCO, and Cochrane databases (June 2018).
• Inclusion of studies assessing free tissue transfer outcomes in hypercoagulable patients.
• Exclusion of case reports and reviews; data extraction on anticoagulation, complications, and outcomes.

Main Results:

• 185 free tissue transfers in 155 thrombophilic patients were analyzed.
• Varied anticoagulation regimens used, often involving intraoperative heparin.
• Late postoperative thromboses were common; intraoperative thromboses had a 36.4% salvage rate, postoperative thromboses had none.
• Preemptive anticoagulation improved outcomes but increased bleeding risk.

Conclusions:

• Free tissue transfer is feasible in hypercoagulable patients with appropriate management.
• Therapeutic anticoagulation initiated intraoperatively is recommended for high-risk patients.
• Careful consideration of bleeding risks versus flap benefits is essential; intraoperative risk factor assessment may guide intervention.