Evidence-Based Approaches to Anticoagulation in Reconstructive Microsurgery-A Systematic Literature Review

Area of Science:

• Microsurgery
• Vascular Surgery
• Pharmacology

Background:

• Thrombotic complications are a major cause of flap failure in microsurgery.
• Balancing anticoagulation for thrombosis prevention against bleeding risks is critical.

Purpose of the Study:

• To systematically review anticoagulation strategies in microsurgical procedures.
• To evaluate the efficacy and safety of different anticoagulants in free flap reconstruction and replantation.

Main Methods:

• Systematic literature search of PubMed for clinical and animal studies.
• Evaluation of 79 relevant articles using the modified Coleman methodology score.
• Meta-analysis of clinical studies on aspirin, heparin, and dextran regimens.

Main Results:

• Heparin and aspirin demonstrated similar flap loss rates.
• High-dose heparin or dalteparin correlated with increased flap loss compared to low doses.
• Dextran use is not recommended due to systemic complications; animal studies suggest topical/intraluminal heparin benefits flap survival.

Conclusions:

• Current evidence suggests low-dose anticoagulation may be optimal, but study quality is low.
• Further large, multi-institutional randomized clinical trials are needed to establish evidence-based guidelines for anticoagulation in microsurgery.