Does Anticoagulation Improve Flap Outcomes in Hypercoagulable Patients? A Systematic Review
Does Anticoagulation Improve Flap Outcomes in Hypercoagulable Patients? A Systematic Review
复制标题
抗凝治疗能否改善高凝患者的皮瓣预后？
DOI：
10.1055/s-0039-3400531
复制
发表时间：
2019
影响因子：
2.1
通讯作者：
J. Ricci
中科院分区：
文献类型：
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作者：
Vasanth S. Kotamarti;Eric Shiah;Kristen Rezak;Ashit Patel;J. Ricci
摘要背景 尽管显微外科技术有了进步，但高凝患者仍然是一个重建的挑战。血栓形成是一种相对常见的问题，其后果可能是灾难性的，包括游离皮瓣丢失。这项研究的目的是评估已知的高凝状态患者进行游离组织移植的现有文献，以制定治疗建议。方法 于2018年6月对PubMed、EBSCO和Cochrane数据库进行了系统评价。纳入标准是对已确定的高凝状态患者进行游离组织移植的结果进行评估。排除标准为综述文章、病例报告和研究，缺乏对抗凝方案和手术结果的详细讨论。收集的数据包括高凝患者的数量、抗凝方案、血栓并发症、皮瓣成功率和出血并发症。采用独立样本t检验进行统计分析。结果14 7篇 结果，纳入4篇文献进行分析。搜索完成后发表的一篇相关文章被收录在内。在155名血栓形成患者中，总共进行了185次游离组织移植。抗凝方案变化很大，但通常包括术中持续肝素，有或没有额外的推注，然后是术后和门诊抗凝。高凝患者术后晚期常出现血栓形成。术中血栓抢救成功率为36.4%。无一例术后血栓形成的皮瓣被挽救。超前抗凝治疗改善了预后，但增加了出血风险。结论 游离组织移植可成功应用于高凝状态的患者。除非有禁忌症，术前确诊的高危患者应接受术中开始的治疗性抗凝治疗。术后血栓形成后抢救能力差。最终，在制定重建计划时，必须逐一考虑游离组织移植的益处和出血并发症的潜在发病率。根据术中危险因素的存在启动抗凝可以防止不必要的干预。
Abstract Background Despite improvements in microsurgical techniques, hypercoagulable patients remain a reconstructive challenge. Thrombophilias are a relatively common problem with potentially catastrophic results including free flap loss. The aim of this study was to assess the available literature on free tissue transfer in patients with known hypercoagulability to develop recommendations for management. Methods A systematic review of the PubMed, EBSCO, and Cochrane databases was performed in June 2018. Inclusion criteria were assessment of outcomes of free tissue transfer in patients with established hypercoagulability. Exclusion criteria were review articles, case reports, and studies lacking detailed discussion of anticoagulation regimens and surgical outcomes. Data collected included the number of hypercoagulable patients, anticoagulation regimens, thrombotic complications, flap success, and bleeding complications. Statistical analysis was performed using independent samples t-tests. Results Of 147 total results, four articles were included for analysis. One relevant article published after search completion was included. In total, 185 free tissue transfers were performed in 155 thrombophilic patients. Anticoagulation regimens varied widely but often included intraoperative continuous heparin, with or without additional bolus, followed by postoperative and outpatient anticoagulation. Hypercoagulable patients often developed late postoperative thromboses. Of the intraoperative thromboses, 36.4% were successfully salvaged. No flaps with postoperative thrombosis were salvaged. Preemptive therapeutic anticoagulation improved outcomes but increased the bleeding risk. Conclusion Free tissue transfer may be successful in hypercoagulable patients. High-risk patients identified preoperatively should receive therapeutic anticoagulation initiated intraoperatively unless contraindicated. Salvage after postoperative thrombosis is poor. Ultimately, the benefits of free tissue transfer must be considered with the potential morbidity of bleeding complications on a case-by-case basis when developing a reconstructive plan. Initiating anticoagulation based on the presence of intraoperative risk factors may prevent unnecessary intervention.
DOI：
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发表时间：
2007
期刊：
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影响因子：
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作者：
G. Lyman;A. Khorana;A. Falanga;D. Clarke‐Pearson;C. Flowers;M. Jahanzeb;A. Kakkar;N. Kuderer;M. Levine;H. Liebman;D. Mendelson;G. Raskob;M. Somerfield;P. Thodiyil;D. Trent;C. Francis
通讯作者：
G. Lyman;A. Khorana;A. Falanga;D. Clarke‐Pearson;C. Flowers;M. Jahanzeb;A. Kakkar;N. Kuderer;M. Levine;H. Liebman;D. Mendelson;G. Raskob;M. Somerfield;P. Thodiyil;D. Trent;C. Francis
DOI：
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发表时间：
2006
期刊：
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影响因子：
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