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Appropriate Use of Intravenous Unfractionated Heparin after Digital Replantation

A Randomized Controlled Trial Involving Three Groups

Nishijima, Akio, M.D., Ph.D.; Yamamoto, Naoto, M.D., Ph.D.; Gosho, Masahiko, Ph.D.; Yanagibayashi, Satoshi, M.D., Ph.D.; Yoshida, Ryuichi, M.D.; Takikawa, Megumi, M.D., Ph.D.; Hayasaka, Rie, M.D.; Nagano, Hisato, M.D.; Maruyama, Eri, M.D.; Sekido, Mitsuru, M.D., Ph.D.

Plastic and Reconstructive Surgery: June 2019 - Volume 143 - Issue 6 - p 1224e–1232e
doi: 10.1097/PRS.0000000000005665
Hand/Peripheral Nerve: Original Articles
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Background: The purpose of this study was to clarify the appropriate use of unfractionated heparin as an anticoagulation agent after digital replantation.

Methods: This study was a prospective, randomized, single-blind, blinded-endpoint method, three-arm, parallel-group, controlled clinical trial conducted at a single institution. A total of 88 patients (101 fingers) following digital amputation and subsequent repair by anastomosis of both arteries and veins were randomly allocated into three groups: (1) control group (no heparin dose), (2) low-dose heparin group (10,000 IU/day), and (3) high-dose heparin group (start at 15,000 IU/day, then adjust the dose to achieve an activated partial thromboplastin time of 1.5 to 2.5 times the baseline). The outcomes were assessed regarding the proportion of success at 2 weeks after replantation of amputated digits, total or partial necrosis, and occurrence of complications.

Results: No significant differences were found among the three groups, except for complications of congestion. The odds ratio of the heparin group compared with the control group for a success proportion was 5.40 (95 percent CI, 0.85 to 34.20; p = 0.027) in subjects aged 50 years or older. Significant elevations of activated partial thromboplastin time, aspartate transaminase, and alanine aminotransferase occurred in high-dose heparin groups on day 7.

Conclusion: Unfractionated heparin administration is considered effective for patients aged 50 years or older, although the routine use of unfractionated heparin is not necessary after digital replantation.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.

Chiba, Ibaraki, Saitama, and Tsukuba, Japan

From the Department of Plastic and Reconstructive Surgery, New Tokyo Hospital; the Department of Plastic and Reconstructive Surgery, University of Tsukuba; the Department of Plastic and Reconstructive Surgery, Jichi Medical University Saitama Medical Center; and the Department of Biostatistics, Faculty of Medicine, University of Tsukuba.

Received for publication July 5, 2018; accepted November 2, 2018.

This trial is registered under the name “The Effect and Proper Dose of Unfractionated Heparin after Digital Replantation: A Prospective Study,” University Hospital Medical Information Network identification number UMIN 000021991 (https://upload.umin.ac.jp/cgi-open-bin/icdr_e/ctr_view.cgi?recptno=R000025303).

Disclosure:None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this article.

Akio Nishijima, M.D., Ph.D., Department of Plastic and Reconstructive Surgery, University of Tsukuba, 2-1-1 Amakubo, Tsukuba, Ibaraki 305-8576, Japan, handbal1016@yahoo.co.jp

©2019American Society of Plastic Surgeons