Postsurgical antithrombotic therapy in microsurgery: our protocol and literature review

Abstract

Objective: Despite the improvements reached by microsurgeons in the last 30 years, postoperative complications still occur and most of them are the result of venous thrombosis at the pedicle anastomosis. Primary prevention of thrombosis is mandatory and anticoagulant therapy in the preoperative and postoperative period is widely used. Still, there is a lack of consensus in the literature about the best postoperative protocol for microsurgical reconstruction. The authors aimed to review the postoperative antithrombotic regimens described in literature focusing on their effects and risks, and moreover, share their experience.

Materials and methods: The authors performed a literature review of postsurgical antithrombotic protocols applied in reconstructive microsurgery. Research on PubMed server was performed typing the terms "antithrombotic", "postoperative", "microsurgery", "free flap pedicle", "anticlotting", "anticoagulant".

Results: The authors described the postoperative standardized pro-weight pharmacological protocol applied in their unit: a combination of dextran and heparin. They inhibit more than one pattern of coagulation in order to stop platelet aggregation and thrombin action and, in the meantime, contending fluid loss with plasma expansion.

Conclusions: Nowadays, a non-standardized practice, based on experience, is applied by microsurgeons in postsurgical care; the authors performed a review of the combined antithrombotic therapies described in the literature. A standardized pro-weight pharmacological protocol is proposed; it allows to increase blood flow by volume expander action (Dextran) and thrombin inhibition (Heparin). Still, coagulation cascade and platelet function have a wide variability among humans, as well as the effect of drugs. Achieving an optimal antithrombotic effect and minimizing adverse reactions meantime remains a challenge.