Should Antiplatelet Therapy Be Withheld Perioperatively? The First Study Examining Outcomes in Patients Receiving Dual Antiplatelet Therapy in the Lower Extremity Free Flap Population

Abstract

ree tissue transfer failure is rare, occurring at a rate of 1 to 5 percent. 1 Failure is most commonly caused by hematoma or thrombus formation, both of which can impede attempts at revascularization and contribute to low rates of salvage (50 to 60 percent success rate). 2,3 Thus, it is vital to free tissue transfer success that prothrombotic and antithrombotic elements be delicately balanced perioperatively so that blood flow is maximized and hematoma formation is minimized. Medical therapy is often divided into two mechanisms of action with respect to thrombus prevention: antiplatelet and anticoagulant. Effects on three outcomes must be considered

Free Tissue Transfer to the Lower Extremity in the Setting of Thrombocytosis and the Role of Antiplatelet Therapy: A Propensity Score–Matched Analysis

“…This discrepancy in outcomes can be anticipated given the multifactorial etiology of hematomas, which differentially arise in populations with heterogeneity regarding surgical indications, technique, medical history, and other pharmacologic exposures. [42][43][44] Although rates of hematoma incidence were statistically similar between groups, the AP group required significantly more intraoperative and postoperative inpatient transfusion units and volume than the non-AP therapy group. While the rates of intraoperative EBL were comparable (p ¼ 0.166), the reliability and accuracy of this measurement has been called into question.…”

“…This discrepancy in outcomes can be anticipated given the multifactorial etiology of hematomas, which differentially arise in populations with heterogeneity regarding surgical indications, technique, medical history, and other pharmacologic exposures. 42 43 44…”