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E Poster discussion: Circulation

Abstract PR042: Does Hypercoagulation Detected By Rotational Thromboelastography (Rotem) Improve Prediction of Free Flap Thrombosis in Microvascular Surgery Patients?

Ozolina, A.1,2,*; Stepanovs, J.1,3; Rovite, V.4; Mamaja, B.1,3; Vanags, I.1

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doi: 10.1213/01.ane.0000492452.01288.9d
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Background & Objectives: Nowadays, there is limited information about prognostic value of hypercoagulation detected by ROTEM for postoperative transferred tissue thrombotic complications. The aim was to evaluate the predictive capacity of hypercoagulation detected by ROTEM for free flap thrombosis in patients undergoing microvascular surgery.

Materials & Methods: In the prospective observational study were enrolled 51 microvascular free flap surgery patients. Demographical data, external thrombogenic factors were recorded. Preoperatively, ROTEM was performed. Two groups of patients: with or without hypercoagulation detected by fibrinogen/platelet ratio (FPR) ≥ 42 were compared. Association between external thrombogenic factors, hypercoagulability in ROTEM and surgical outcomes (free flap thrombosis and free flap necrosis) was analyzed.

Results: 51 patients with mean age 39 ± 13 years were enrolled. External thrombogenic factors were identified for 25 patients: recent trauma 15/51 (29.4%), ischemic heart disease and atherosclerosis 6/51(12%), tetra-, para paresis or neurofibromatosis 3/51 (6%), obesity + recent trauma 1/51 (2%). Hypercoagulation in ROTEM was detected in 15 patients ((FPR) ≥ 42), mostly in those with external thrombogenic factors -13 (52%) out of 25. The main reason (67%) was recent trauma. Patients with preoperative hypercoagulation had significantly higher values of MCFEXTEM (p <0,001), MCFINTEM (p < 0,001), MCF FIBTEM (p < 0,001), and significantly lower - CFTEXTEM (p= 0,01), CFTINTEM (p= 0,02). Incidence of free flap thrombosis was significantly higher in ROTEM hypercoagulability compared to group without, 5/15 (33%) vs. 4/36 (11%), p = 0.047. Thrombosis and necrosis more often developed in patients with external thrombogenic factors comparing to others, 8 vs. 1 and 8 vs. 2, p = 0.008 and p = 0.03. The AUC for hypercoagulation detected by ROTEM to predict free flap thrombosis was 0.7 (p = 0.05). The highest correlation was revealed between MCFINTEM and incidence of free flap thrombosis, r = 0.3; p = 0.04.

Conclusion: ROTEM is a suitable method to detect hypercoagulability preoperatively with definite predictive capacity for postoperative free flap thrombosis in microvascular surgery. Patient thrombogenic factors have notable influence on free flap surgery results, and routine usage of ROTEM test can early identify patients in high risk for transferred tissue failure.

References:

Senchenkov, A. et al.(2015). Management of perioperative microvascular thrombotic complications - The use of multiagent anticoagulation algorithm in 395 consecutive free flaps. J of Plastic, reconstructive & Aesthetic Surgery, 68(9), 1293–1303

Disclosure of Interest: None declared

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