Does anticoagulation improve outcomes of microvascular free flap reconstruction following head and neck surgery: a systematic review and meta-analysis |
| |
| Affiliation: | 1. Specialty Trainee Oral & Maxillofacial Surgery, Manchester University NHS Foundation Trust, United Kingdom;2. Specialty Trainee Oral & Maxillofacial Surgery, University Hospital of Wales, Cardiff, United Kingdom;3. Consultant Oral & Maxillofacial Surgery, Royal Preston Hospital, Lancashire Teaching Hospitals NHS Foundation Trust, United Kingdom;4. Consultant Oral & Maxillofacial Surgery, Manchester University NHS Foundation Trust, United Kingdom;5. Consultant Oral & Maxillofacial Surgery, East Lancashire Hospitals NHS Trust – University of Central Lancashire, United Kingdom;1. Oral and Maxillofacial Surgery Department, Queen Elizabeth Hospital, 1345 Govan Road, Glasgow G51 4TF, Scotland;2. Glasgow Medical School, University Avenue, Glasgow G12 8QQ, Scotland;1. Oral and Maxillofacial Surgery Unit, Queen Alexandra Hospital, Portsmouth PO6 3LY, UK;2. Department of Colorectal and General Surgery, The Royal Wolverhampton NHS Trust, New Cross Hospital, Wolverhampton WV10 0QP, UK;3. Department of Orthopaedics, Great Ormond St Hospital for Children, London WC1N 3JH, UK;1. Department of Plastic and Aesthetic Surgery, First Hospital of Jilin University, 71 Xinmin Street, Changchun 130021, People’s Republic of China;2. Department of Oncology, First Hospital of Jilin University, 71 Xinmin Street, Changchun 130021, People’s Republic of China;1. ENT and Cervicofacial Surgery Department, Fundación Jiménez Díaz University Hospital, Madrid, Spain;2. ENT and Cervicofacial Surgery Department. Villalba General University Hospital, Collado Villalba, Spain;3. Departamento de Mineralogía y Petrología, de la Facultad de Ciencias Geológicas de la Universidad Complutense de Madrid, Spain;4. Instituto de Investigación Sanitaria, Research Unit. Fundación Jiménez Diaz University Hospital, Madrid, Spain |
| |
| Abstract: | The commonest cause of microvascular free flap failure is thrombosis at the anastomosis. Pharmacological antithrombotic therapies have been used to mitigate this risk, but they carry the risk of bleeding and haematoma formation. To justify any intervention, it is necessary to evaluate the benefits and balance of risks. This meta-analysis aims to quantify the value of systemic anticoagulation during head and neck free tissue reconstruction. We performed a systematic review on the impact of additional prophylactic antithrombotic therapy on head and neck (H&N) free tissue transfer (on top and above the use of low molecular weight heparin to prevent deep vein thrombosis). We carried a PRISMA-guided literature review, following registration with PROSPERO. All studies analysing the possible impact of prophylactic anticoagulants on free flap surgery in the head and neck were eligible. The primary outcome was perioperative free flap complications (perioperative thrombosis, partial or total free flap failure, thrombo-embolic events, or re-exploration of anastomosis). Secondary outcomes included haematoma formation or bleeding complications requiring further intervention. We identified eight eligible studies out of 454. These included 3531 free flaps for H&N reconstruction. None of the assessed interventions demonstrated a statistically significant improvement in free flap outcomes. Accumulative analysis of all anti-coagulated groups demonstrated an increased relative risk of free flap complications [RR 1.54 (0.73–3.23)] compared to control albeit not statistically significant (p = 0.25). Pooled analysis from the included studies showed that the prophylactic use of therapeutic doses of anticoagulants significantly (p = 0.003) increased the risk of haematoma and bleeding requiring intervention [RR 2.98 (1.47-6.07)], without reducing the risk of free flap failure. Additional anticoagulation does not reduce the incidence of free flap thrombosis and failure. Unfractionated heparin (UFH) consistently increased the risk of free flap complications. The use of additional anticoagulation as ‘prophylaxis’ in the perioperative setting, increases the risk of haematoma and bleeding. |
| |
| Keywords: | Flaps Heparin Anticoagulation LMWH Bleeding Hematoma Flap failure Complications |
| 本文献已被 ScienceDirect 等数据库收录！ |
|
