LMWH prophylaxis after digital replantation and early vascular compromise

Early vascular compromise remains a major cause of failure after digital replantation, and the optimal low-molecular-weight heparin (LMWH) regimen remains unclear. This study compared intensified versus standard LMWH prophylaxis for preventing early vascular compromise after digital replantation.

In this single-center retrospective cohort study, consecutive adult patients undergoing digital replantation (2023-2025) were included. All procedures were performed by one microsurgeon. Postoperative LMWH was administered subcutaneously for 7 days as either 5000 international units once daily (QD) or twice daily (BID), according to a preexisting department protocol. The primary endpoint was a composite of early vascular compromise, including vascular crisis, re-exploration, therapeutic bloodletting/leech therapy, or digit failure.

Sixty-nine patients (85 digits) were included (QD: 39 patients; BID: 30 patients). The primary endpoint occurred in 12/39 patients in the QD group versus 1/30 in the BID group. All vascular crises were venous. Digit failure occurred in 5 QD patients, and none in the BID group. No bleeding or transfusion events were observed.

Twice-daily LMWH prophylaxis was associated with fewer early vascular compromise events after digital replantation compared with once-daily dosing. These findings are hypothesis-generating and require prospective validation.