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Risk Factors for Early Deep Vein Thrombosis After Free-Flap Reconstruction for Head and Neck Cancer Despite Routine
ZhongYi Sun1, JingJing Li2, PengFei Zhao3
1Director, Department of Stomatology, Sijing Hospital of Songjiang District, Shanghai, China.
Background:
Deep vein thrombosis (DVT) remains a clinically relevant complication after head and neck cancer (HNC) surgery with free-flap reconstruction despite routine anticoagulation, particularly during the early postoperative period.
Purpose:
To identify factors associated with very early postoperative DVT.
Study Design, Setting, Sample:
This retrospective cohort study included patients who underwent radical resection of pathologically confirmed HNC with simultaneous free-flap reconstruction at Shanghai Ninth People's Hospital between January 2024 and July 2025. Patients without pathologically confirmed HNC or without radical surgery with free-flap reconstruction were excluded.
Predictor Variables:
The predictor variable was a set of heterogeneous factors categorized as demographic, clinical, and treatment-related factors, as well as perioperative laboratory parameters, particularly platelet-related indices and their dynamic changes.
Main Outcome Variables:
Early DVT, defined as DVT occurring within 72 hours postoperatively and confirmed by duplex ultrasonography.
Covariates:
Not applicable.
Analyses:
Continuous variables were compared using the independent-samples t-test or Mann-Whitney U test, and categorical variables using the χ2 or Fisher's exact test. Relative risks were calculated for univariable analyses. Variables with P ≤ .20 and clinically relevant variables were entered into a multivariable logistic regression model. Changes in coagulation and platelet-related parameters among patients with DVT were evaluated using the Wilcoxon signed-rank test. Statistical significance was defined as P < .05.
Results:
A total of 276 patients were enrolled, of whom 14 (5.1%) developed DVT within 72 hours. Multivariable analysis identified tumor size >3.5 cm (odds ratio = 4.64, 95% CI: 1.47 to 14.67; P = .01) and operative time >450 minutes (odds ratio = 3.72, 95% CI: 1.07 to 12.98; P = .04) were independently associated with early DVT. Among patients who developed DVT, platelet count (P = .006), plateletcrit (P = .005), antithrombin III (P = .004), and thromboelastography reaction time (P = .02) decreased significantly at the time of DVT diagnosis, whereas D-dimer (P = .002) and fibrin degradation product levels (P = .01) increased significantly.
Conclusions And Relevance:
Early DVT may occur despite routine heparin prophylaxis. Larger tumor size and prolonged operative duration were independent risk factors. Changes in coagulation, thromboelastography, and platelet-related parameters suggest a multifactorial thrombotic process involving coagulation activation, antithrombin III depletion, and platelet consumption, which may aid early risk stratification.
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