Perioperative Thromboprophylaxis in Digital Replantation: A Systematic Review

Reissis, Dimitris; Geoghegan, Luke; Sarsam, Raghda; Sing, Quillan Young; Nikkhah, Dariush

doi:10.1097/gox.0000000000002806

Cited by 7 publications

(8 citation statements)

References 20 publications

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“…Thus, low-quality evidence shows that a therapeutic dose of intravenous unfractionated heparin leads to a higher risk of complications when compared with heparin given as an intermittent bolus of unfractionated heparin or subcutaneous heparin, or prostaglandin E1 or no heparin. These results differ from two recent systematic reviews (including one with meta-analysis) that did not find clear evidence of higher complications associated with perioperative thromboprophylaxis in digital replantation (Lin et al, 2020;Reissis et al, 2020).The meta-analysis compared unfractionated heparin use with low-molecular weight heparin and found no clear evidence of higher complications associated with unfractionated heparin use following digit replantation (Lin et al, 2020). However, it should be underlined that unfractionated heparin was administered subcutaneously in one of the studies included in this meta-analysis (Li et al, 2012).…”

Section: Discussioncontrasting

confidence: 99%

“…Twenty-six full-text articles were assessed for eligibility. Twenty of these were excluded (Askari et al, 2006;Buntic & Brooks, 2010;Chen et al, 2021;Couteau et al, 2018;Efanov, 2017;Fukui et al, 1989;Herlihy et al, 2020;Li et al, 2012;Lin et al, 2020;Loisel et al, 2010;Luthringer et al, 2020;Maeda et al, 1991;Noguchi et al, 1999;Noh & Hacquebord, 2020;Pickrell et al, 2020;Reissis et al, 2020;Shaterian et al, 2018;Shi et al, 2013).Other than a prospective trial initiated by some members of our research team (NLM, 2021), the search in EBM reviews did not find other ongoing clinical trials, health technology assessment reports or guidelines. The manual search for relevant gray literature did not allow finding relevant studies either.…”

Section: Resultsmentioning

confidence: 99%

“…However, to date there is no consensus or strong evidence on the efficacy and safety of perioperative thromboprophylaxis in digital replantation (Lin et al, 2020; Reissis et al, 2020). Reported complications following anticoagulation post digital surgery include bleeding, heparin‐induced thrombocytopenia (HIT), hyperkalemia, and hypersensitivity reactions (Askari et al, 2006; Levin & Cooper, 2008).…”

Section: Introductionmentioning

confidence: 99%

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The clinical effectiveness and safety of intravenous unfractionated heparin following digital replantation and revascularization: A narrative systematic review

et al. 2022

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Background: Digital replants and revascularization (DRV) have been performed since the 1960s but there are no recognized standard peri-operative anticoagulation practices. A narrative systematic review of the clinical effectiveness and safety of therapeutic peri-operative unfractionated heparin following DRV was undertaken.Methods: A review of the literature from 1985 to March 2022 was conducted using Medline, Embase, CINAHL and EBM reviews. Unfractionated heparin (UFH) use following DRV was compared to low-molecular weight heparin, other anticoagulants or no anticoagulation. Randomized trials, observational studies as well as guidelines were selected and independently screened. The Revised Cochrane risk-of-bias (RoB 2) tool and ROBINS-I were used to appraise risk of bias.Results: While the search strategy identified 1490 references, only six studies met the inclusion criteria. Significant heterogeneity and the low methodological quality of the evidence precluded a meta-analysis. Among the four studies that documented the surgical success rate associated with the use of a therapeutic dose of UFH post DRV, only two reported improved clinical outcomes. Evidence of a higher complication rate related to UFH use was found in four studies. Low quality evidence suggests that a therapeutic dose of unfractionated heparin leads to a higher risk of complications when compared with heparin given as an intermittent bolus of unfractionated heparin or subcutaneous heparin, or prostaglandin E1 or no heparin.Conclusions: Current evidence suggests that IV UFH use following DRV has no significant impact on the success of the intervention. Heparin use may not be innocuous as some studies showed increased bleeding complications.

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Section: Discussioncontrasting

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The clinical effectiveness and safety of intravenous unfractionated heparin following digital replantation and revascularization: A narrative systematic review

et al. 2022

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“…Oral ASA was administered to prevent arterial occlusion. There are several publications on perioperative and postoperative anticoagulant medication ( DeFazio et al., 2016 ; Lee et al., 2016 ; Nishijima et al., 2019 ; Reissis et al., 2020 ; Retrouvey et al., 2019 ; Zhu et al., 2017 ). Nevertheless, the benefits of anticoagulant medication during or after replantation surgery remain unclear.…”

Section: Discussionmentioning

confidence: 99%

Indications, anaesthesia and postoperative protocol for replantation and revascularization in the hand in Nordic countries

Rönkkö

Sletten

Hansen

et al. 2022

J Hand Surg Eur Vol

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In this survey, we compared the current postoperative practices in the largest replantation units of four Nordic countries. The topics included were indication for surgery, anaesthesia, postoperative monitoring, use of antibiotics, anticoagulation and postoperative intravenous fluids, change of dressings, duration of bed rest and hospital stay, hand therapy and follow-up after discharge. Although there were many similarities between the units in the postoperative protocols, we found a large variety of practices. There is no robust evidence to assess or support or reject most of the strategies in postoperative care. The differences in practice warrant prospective studies in order to establish an evidence-based postoperative protocol for replantation surgery.

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“…In the past, there have been studies reporting the results of replantation of Tamai Zone 2 and more proximal finger amputations, but only a few studies have reported the results of replantation at more distal (Tamai Zone 1) regions [8,9]. In distal-level injuries, the debate about utilizing replantation, local flaps, or other similar repair techniques that require less microsurgical experience is still ongoing [10][11][12][13].…”

Section: Introductionmentioning

confidence: 99%

Supermicrosurgical Experience pertaining to Replantation of Tamai Zone 1 Fingertip Amputations

Pamuk¹

2022

Handchir Mikrochir Plast Chir

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With the advent of supermicrosurgery, the replantation of very distal finger amputations has become possible. The choice between replantation or flap surgeries in the treatment of Tamai Zone I finger amputations continues to be a matter of debate. This study aims to evaluate replantation results in Tamai Zone 1 finger amputations. The demographic characteristics and clinical results of 39 patients undergoing replantation for a Tamai Zone 1 finger amputation between 2018 and 2021 were retrospectively analyzed. The Cold Intolerance Severity Score (CISS), two-point discrimination test (2-PD) and Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) were calculated and recorded after a minimum follow-up period of 6 months. The great majority of patients were males (92.3%, n=36) who had suffered the injuries during work accidents (89.7%, n=35). The socioeconomic status of the patients showed a homogeneous distribution. Replant survival was achieved in 69.2% (n=27) of all fingers. The duration of the surgical procedure in patients who underwent vein repair was significantly longer (p<0.001). However, there was no significant relationship between vein repair and survival rate (p=0.348). This study shows that replantation is a surgical intervention that should be given priority in patients with Tamai Zone 1 amputations. In most cases of unsuccessful replantation, secondary recovery results are also acceptable. Future studies with larger case series are needed.

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Perioperative Thromboprophylaxis in Digital Replantation: A Systematic Review

Abstract: Supplemental Digital Content is available in the text.

Cited by 7 publications

References 20 publications

The clinical effectiveness and safety of intravenous unfractionated heparin following digital replantation and revascularization: A narrative systematic review

The clinical effectiveness and safety of intravenous unfractionated heparin following digital replantation and revascularization: A narrative systematic review

Indications, anaesthesia and postoperative protocol for replantation and revascularization in the hand in Nordic countries

Supermicrosurgical Experience pertaining to Replantation of Tamai Zone 1 Fingertip Amputations

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