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Role of Postoperative Anticoagulation in Predicting Digit Replantation and Revascularization Failure

A Propensity-matched Cohort Study

Retrouvey, Helene MDCM*; Solaja, Ogi MD; Baltzer, Heather L. MSc, MD, FRCSC, FACS*

doi: 10.1097/SAP.0000000000001848

Purpose The use of intravenous heparin after digit replantation or revascularization (DRR) varies greatly. The insufficient evidence presents a lack of clinical equipoise needed for a randomized trial; as such, a matched propensity score analysis was performed to evaluate the role of postoperative anticoagulation after DRR. The purpose of this study was to determine if the use of postoperative therapeutic anticoagulation reduced the risk of digit failure.

Methods A retrospective cohort of patients who underwent DRR from 2005 to 2016 was identified. A propensity score was calculated based on age, smoking, injury mechanism, procedure type, vein graft, and number of digits injured. Patients were matched 1:2 by propensity score to create 2 groups with similar risks of receiving anticoagulation postoperatively. Generalized estimating equation logistic model was used to determine differences in digit failure between groups.

Results Digit replantation or revascularization was performed on 282 patients (92% male; median age, 43 years). Postoperative anticoagulation was administered in 69 (24%) patients, with continuous IV heparin in 34 patients and intravenous heparin with dextran in 35 patients. Digit failure occurred in 88 patients overall, representing 38% of patients receiving anticoagulation and 29% of those not. Major complications were higher among the anticoagulated patients (13% vs 3.3%). After propensity score matching, use of anticoagulation was not associated with digit failure (odds ratio, 0.79; 95% confidence interval, 0.47–1.32).

Conclusions Among DRR patients with similar predisposing characteristics for postoperative therapeutic heparin or dextran, the use of therapeutic anticoagulation does not have a protective effect against digit failure. Studies are needed to define the role of postoperative IV anticoagulation in DRR and to justify the risk of its administration.

From the *Division of Plastic and Reconstructive Surgery, University of Toronto

Division of Plastic and Reconstructive Surgery, McMaster University, Toronto, Ontario, Canada.

Received September 27, 2018, and accepted for publication, after revision December 27, 2018.

Conflicts of Interest and Source of Funding: none declared.

Reprints: Heather L. Baltzer, MSc, MD, FRCSC, Division of Plastic and Reconstructive Surgery, Toronto Western Hospital, University of Toronto, Rm 422, 399 Bathurst St, East Wing 2nd Floor, Toronto, Ontario, Canada M5T 2S8. E-mail:

Online date: June 7, 2019

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