Ethnic Disparities in Thrombotic and Bleeding Diatheses Revisited: A Systematic Review of Microsurgical Breast Reconstruction across the East and West

Abstract

Background Ethnicity has been shown to play a role in disparate coagulative responses between East Asian and Caucasian patients undergoing nonmicrovascular surgery. In this study, we sought to further investigate this hematologic phenomenon between the two ethnic groups within the field of microsurgical breast reconstruction. Methods A systematic review examining the reported incidence of microvascular thrombosis and all-site bleeding among breast free flaps in East Asians and Westerners was performed. Statistical analysis was performed using the chi-square test. Results Ten East Asian studies with 581 flaps and 99 Western studies with 30,767 flaps were included. A statistically significant higher rate of thrombotic complications was found in Westerners compared with East Asians (4.2 vs. 2.2%, p = 0.02). Conversely, bleeding events were more common in East Asians compared with Westerners (2.6 vs. 1.2%, p = 0.002). Conclusion There appears to be an ethnicity-based propensity for thrombosis in Westerners and, conversely, for bleeding in East Asians, as evident by the current systematic review of microvascular breast reconstruction data. It is therefore advisable to consider ethnicity in the comprehensive evaluation of patients undergoing microsurgical procedures.

Venous thromboembolism among Asian populations with localized colorectal cancer undergoing curative resection: is pharmacological thromboprophylaxis required? A systematic review and meta-analysis

“…crosurgical breast reconstruction. That study reported a significantly higher rate of bleeding events in Asian patients than in Western patients (2.6% vs. 1.2%, P = 0.002) [37]. These findings further augment the emerging body of evidence suggesting possible differences in the coagulative responses between Asian and Western populations [33,37].…”

“…That study reported a significantly higher rate of bleeding events in Asian patients than in Western patients (2.6% vs. 1.2%, P = 0.002) [37]. These findings further augment the emerging body of evidence suggesting possible differences in the coagulative responses between Asian and Western populations [33,37]. As such, the introduction of PTP in this population group should be a calculated decision, one that takes into account the intrinsic differences in hemostatic pathways that result in a lower incidence of VTE events and conversely, higher bleeding risks.…”

Genomic Analysis of Thrombophilia Variants in the General Population for the Creation of an Effective Preoperative Screening Tool

“…A systematic review comparing the East Asian population to the Western population found that Westerners were more susceptible to microvascular thrombosis while Eastern Asians were at increased risk of all site bleeding during breast free flap reconstruction. 25 These findings suggest clinically significant differences in the rate of thrombosis, as well as the propensity to inordinately bleed among different ethnic populations, both of which can significantly increase morbidity and mortality among microvascular surgery patients. Further research is necessary to elucidate links between unique genetic polymorphisms and hypercoagulable states within homogenous racial groups.…”

Ex Vivo Thrombolysis to Salvage Free Flaps Using Machine Perfusion: A Pilot Study in a Porcine Model

“…Such circumstances disparate coagulative responses and potential susceptibility to pharmacologic intervention. 52 53 The authors are also aware that ischemia-reperfusions injuries under which microcapillary venous flap thrombosis typically occurs differ from the model that is presented. In addition, this study includes mostly semiquantitative analysis and lacks data on tissue oxygen tension, perfusate samples, and histologic evaluation.…”