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J Reconstr Microsurg 2011; 27(1): 057-062
DOI: 10.1055/s-0030-1267830
© Thieme Medical Publishers

Differences in Coagulation Among Asians and Caucasians and the Implication for Reconstructive Microsurgery

Dhruv Singhal1 , Emmanuil Smorodinsky2 , Lifei Guo1
  • 1Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
  • 2Tufts School of Medicine, Boston, Massachusetts
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Publication History

Publication Date:
25 October 2010 (online)

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ABSTRACT

Microvascular reconstructive surgery has seen a revival with the introduction of muscle-sparing perforator flaps. Recognition of potential ethnic differences in coagulation profiles would be important to a microvascular surgeon. Based on clinical observations, we hypothesize that Asian patients have a less thrombogenic coagulation profile than Caucasians. An extensive retrospective review was performed. The annual incidence of venous thromboembolism in the United States is generally accepted to range from 70 to 120 events per 100,000 people versus 16 to 17 events per 100,000 persons in Asia. Autopsy analysis of pulmonary embolism incidence was noted to be 15% in North Americans and less than 1% in Asian populations. Thromboelastography analysis of Asian and Caucasian patients undergoing cholecystectomy revealed different hemostatic mechanisms. Comparison of Asians and Caucasians undergoing the Fontan procedure revealed significantly lower postoperative factor levels in Asians than Caucasians. Baseline comparison of factor and serum levels revealed Asians with the least thrombogenic profiles compared with other ethnic groups. Asians and Caucasians demonstrate different baseline rates of deep vein thrombosis and pulmonary embolism, different hemostatic responses to surgery, and different baseline levels of clotting factors. Further study may lead to better pre-, intra-, and postoperative care of the free flap patient based on their ethnic coagulation profile.

KEYWORDS

Coagulation - Asian - Caucasian

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Lifei GuoM.D. Ph.D. 

Division of Plastic Surgery, Brigham and Women's Hospital

Harvard Medical School, 75 Francis Street, Boston, MA 02115

Email: lguo@partners.org

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