Floor plan - 2013 Annual Meeting - American Association for Hand ...

Anticoagulation in Digital Revascularization and Reimplantation Surgery: a Complete Analysis
of Beneficial and Detrimental Effects
Institution where the work was prepared: Montreal University Health Care Center, Montreal, Canada
Youssef Tahiri, medical, student; Patrick Harris, MD; Genevieve Landes, MD; Valerie Lemaine, MD; Andreas Nikolis,
MD; UniversitÈ de MontrÈal, HÙpital Notre-Dame
INTRODUCTION:
Anticoagulation administration in digital replantation microsurgery is not without serious consequences. Furthermore, no consensus exists
among microsurgeons regarding indications, timing and duration of medication administration. The aim of the study is to better establish
the efficacy and risks associated with three different thromboprophylaxis regimens commonly used in digital replantation microsurgery.
MATERIALS/METHODS:
All patients consecutively treated at a specialized microsurgical replantation center from April 2004 to April 2006 were evaluated. All
traumatically severed digits revascularized or reimplanted over the study period were included. Demographic data, injury characteristics,
as well as type, dosage, duration and timing of medication administration for thromboprophylaxis were assessed. Primary endpoints
with respect of thromboprophylaxis regimens efficacy and risks were i) the proportion of successfully replanted digits at the
moment of patient discharge and ii) the incidence of complications in the immediate and short term post-operative periods.
Proportions were compared by using X≤ tests and multivariate analyses were conducted with logistic regression.
RESULTS:
Over a 2-year period, 151 digits were treated: 91 revascularization and 60 reimplantation procedures. Sixty-five percent of digits received
pre-operative aspirin at dosing of 325 mg. Overall, 98.0% of the digits received post-operative thromboprophylaxis regimens: 51,0%
received aspirin 80 mg once daily plus subcutaneous heparin 5000 U twice daily (group A; n=77) for a mean duration of 4.8 days (±1.4
days), 33.1% received aspirin 80 mg once daily plus IV heparin (group B; n=50) for a mean duration of 5.3 days (±1.9 days), and 13.9%
received two weeks of aspirin 80 mg once daily (group C; n=21). Success rates at discharge were as following: group A 96.1%, group B
90.0%, and group C 85.7% (p=0.191). Short term complication rates in groups A, B, and C were similar at 24.7%, 42.0%, and 33.3%
respectively (p=0.121). Controlling for age, smoking status and the intervention performed, the type of anticoagulation regimen was
not significantly related to success rates, whereas digits on IV heparin had a 2.4 times greater risk of complication than digits on subcutaneous
heparin (95% CI, 1.5-5.4).
CONCLUSION:
Important discrepancies were outlined in the administration of anticoagulation regimens in digital replantation surgery. When considering
short-term outcomes following microsurgical digital reimplantation and revascularization interventions, no significant survival differences
were identified based on the type of regimen used. Digits receiving IV heparin had a significantly greater risk of post-operative
complications than those receiving subcutaneous heparin.
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