Background: Postoperative anticoagulation is widely used in microsurgical flap reconstruction
to reduce the risk of thrombosis and flap complications. However, their effectiveness
and safety in relation to flap outcomes remain uncertain. This systematic review and
meta-analysis evaluates the existing evidence on postoperative anticoagulant use in
microsurgical flap reconstruction.
Methods: A literature search was performed in PubMed database for studies published
from 1995 until January 2025 that compared flap outcomes with postoperative prophylactic
anticoagulation regimens in microsurgical flap procedures. Outcomes of interest included
hematoma, complete flap failure, and reoperation. Relevant data were extracted and
analyzed using meta-analytic techniques.
Results: In total, 11 studies were included in the final review and meta-analysis.
Seven studies comparing patients who received postoperative anticoagulation with those
who did not demonstrate a significantly higher rate of hematoma in the anticoagulated
group (5.0% vs. 3.0%; p = 0.03). However, there were no significant differences in
flap failure or reoperation rates. In subgroup analyses, only studies using UFH showed
increased hematoma risk, whereas LMWH showed no significant effect. Four studies compared
patients receiving postoperative anticoagulation plus aspirin with those receiving
anticoagulation alone and found a higher reoperation rate when aspirin was added (17.5%
vs. 10.0%; p < 0.01), with no significant differences in flap failure rates.
Conclusion: Postoperative heparin increases the risk of hematoma without improving
flap survival. Additionally, combining aspirin with LMWH may increase reoperation
rates. These results suggest that routine anticoagulation may not benefit all patients
and support a risk-based approach to postoperative management in microsurgical reconstruction.
