Abstract
Background
Patients with head and neck tumors undergoing free flap reconstructions are at high
risk of postoperative venous thromboembolism (VTE). To date, no specific guidelines
are available regarding VTE prophylaxis in this patient group. This study aims to
contribute to this scarcity of information by reviewing the literature regarding anticoagulation
regimens in this patient group and evaluating the efficacy and safety of postoperative
subcutaneous heparin dosed at 5,000 units every 8 hours routinely utilized at our
institution.
Methods
PubMed and Embase databases were searched from inception until November 2023. Data
were collected and levels of evidence were evaluated according to the Oxford Centre
for Evidence Based Medicine guidelines. Additionally, a retrospective review of all
patients with head and neck tumors undergoing free tissue transfer at our institution
between 2015 and 2021 was performed. Patients were restricted to those receiving 5,000
units of subcutaneous heparin every 8 hours postoperatively. Key outcomes included
rates of VTE and surgical site hematoma.
Results
This systematic review found 15 studies eligible for inclusion ranging from 1998 to
2023. Anticoagulation regimens were markedly heterogenous. Among the literature, VTE
rates reported ranged from 0 to 9.6% and bleeding rates ranged between 3.5 and 29%.
Our 6-year institutional analysis revealed 393 total patients. Overall, three episodes
of VTE were identified (0.76%) consisting of one deep vein thrombosis and two pulmonary
emboli. The overall rate of hematoma was 9.4% with a higher rate of hematoma at the
recipient site (8.1%) than the donor site (1.3%).
Conclusion
When compared with the existing literature this study found a low rate of VTE and
a comparable incidence postoperative hematoma. This suggests that 5,000 units of subcutaneous
heparin given every 8 hours may be a safe and effective postoperative anticoagulation
regimen for these patients.
Keywords anticoagulation - free flap - hematoma - head and neck cancer - venous thromboembolism
