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Full versus Baby Dose Aspirin for Antithrombotic Prophylaxis in Free Tissue Transfer: Does Size Matter?
Efstathios Karamanos1, Rajaie Hazboun1, Noah Saad1
1The University of Texas Health Science Center at San Antonio, San Antonio, Tex.
Insights
Full-dose aspirin is not superior to baby aspirin for preventing arterial thrombosis after free tissue transfer. Both doses showed similar outcomes in preventing arterial anastomosis revisions and flap complications.
Area of Science:
- Plastic Surgery
- Vascular Surgery
- Pharmacology
Background:
- Postoperative aspirin is common after free tissue transfer.
- Baby aspirin (81 mg) use is increasing.
- Evidence comparing aspirin doses in this context is limited.
Purpose of the Study:
- To compare the efficacy of full-dose versus baby-dose aspirin in preventing arterial thrombosis after free tissue transfer.
- To determine if full-dose aspirin is non-inferior to baby-dose aspirin.
Main Methods:
- Retrospective review of 183 patients undergoing free tissue transfer (2008-2020).
- Patients divided into full-dose (n=78) and baby-dose (n=105) aspirin groups.
- Primary outcome: revision of arterial anastomosis; Secondary outcomes: flap complications.
Main Results:
- No significant difference in arterial anastomosis revision rates between groups (7.6% vs. 7.7%).
- Similar rates of complete/partial flap loss, wound dehiscence, and infection.
- No aspirin-related gastrointestinal complications reported.
Conclusions:
- Arterial thrombosis is rare after free tissue transfer.
- Full-dose aspirin is not superior to baby-dose aspirin in preventing arterial complications.
- Baby aspirin is a viable alternative for preventing thrombosis post-procedure.
Abstract:
The postoperative prophylactic use of aspirin is a common practice among plastic surgeons after free tissue transfer. The use of baby aspirin (81 mg) has become more popular due to previously published literature in other fields. We hypothesized that a full dose daily aspirin is nonsuperior to a baby dose daily aspirin in preventing arterial thrombosis in free tissue transfer.
Methods:
All patients undergoing free tissue transfer of the extremities from 2008 to 2020 were retrospectively reviewed. They were divided into two groups based on the postoperative dose of aspirin administered (full versus baby dose). The decision to administer full or baby dose was based on the surgeon's preference. Primary outcome was revision of the arterial anastomosis. Secondary outcomes included flap complications.
Results:
A total of 183 patients were identified. Out of those, 78 patients received full dose aspirin postoperatively, whereas 105 received a baby dose of aspirin. Patients who received baby aspirin did not have a higher incidence of returning to the operating room for revision of their arterial anastomosis [7.6% versus 7.7%; adjusted odds ratio, 0.93 (95% confidence interval, 0.28-3.11); adjusted P, 0.906]. No differences were found between the two groups in complete and partial flap loss, wound dehiscence, or infection. None of the patients experienced any aspirin-related gastrointestinal complications.
Conclusions:
In patients undergoing free tissue transfer, thrombosis of the arterial anastomosis is rare. Administration of a full dose of aspirin postoperatively was not superior to a baby dose of aspirin in preventing arterial-related complications.
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