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J Reconstr Microsurg
DOI: 10.1055/a-2483-5277
Original Article

Efficacy and Safety of Subcutaneous Unfractionated Heparin Administered Every 8 hours for Venous Thromboembolism Prophylaxis in Reconstructive Head and Neck Tumor Patients: A Systematic Review and 6-Year Institutional Case Series

Jevan Cevik 
1   Plastic and Reconstructive Surgery Unit, The Royal Melbourne Hospital, Parkville, Victoria, Australia
,
David P. Newland
1   Plastic and Reconstructive Surgery Unit, The Royal Melbourne Hospital, Parkville, Victoria, Australia
,
Edward Cheong
1   Plastic and Reconstructive Surgery Unit, The Royal Melbourne Hospital, Parkville, Victoria, Australia
,
Miguel Cabalag
1   Plastic and Reconstructive Surgery Unit, The Royal Melbourne Hospital, Parkville, Victoria, Australia
2   Department of Surgery, The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia
,
Anand Ramakrishnan 
1   Plastic and Reconstructive Surgery Unit, The Royal Melbourne Hospital, Parkville, Victoria, Australia
2   Department of Surgery, The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia
› Author Affiliations
Funding None.
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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


Publication History

Received: 07 February 2024

Accepted: 10 November 2024

Accepted Manuscript online:
25 November 2024

Article published online:
26 December 2024

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