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J Reconstr Microsurg 2014; 30(01): 065-070
DOI: 10.1055/s-0033-1356553
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Effect of Acetylsalicylic Acid on Microvascular Thrombosis in Autologous Breast Reconstruction

Morteza Enajat
1   Department of Plastic and Reconstructive Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
2   Department of Plastic and Reconstructive Surgery, Erasmus MC, University Medical Center Rotterdam, The Netherlands
,
Mujzgan Aziz Mohammadi
1   Department of Plastic and Reconstructive Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
,
Jan Debeij
2   Department of Plastic and Reconstructive Surgery, Erasmus MC, University Medical Center Rotterdam, The Netherlands
,
Rene R. W. J. van der Hulst
1   Department of Plastic and Reconstructive Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
,
Marc A. M. Mureau
2   Department of Plastic and Reconstructive Surgery, Erasmus MC, University Medical Center Rotterdam, The Netherlands
› Author Affiliations
Further Information

Publication History

14 May 2013

20 July 2013

Publication Date:
10 September 2013 (online)

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Abstract

Although advances in microsurgery have increased success rates of autologous breast reconstruction, microvascular thrombosis still remains a major concern as a cause of flap failure. At present, no evidence-based guidelines on pharmacological prevention of microvascular thrombosis exist. This study investigates the effect of acetylsalicylic acid on the incidence of microvascular complications in patients undergoing autologous breast reconstruction.

Patients undergoing deep inferior epigastric artery perforator or free transverse rectus abdominis myocutaneous flap breast reconstruction at two academic centers in the Netherlands between 2005 and 2011 were included. Patients at one center received once daily 0.6 mL of nadroparine and 40 mg acetylsalicylic acid, while patients at the other center received 0.6 mL nadroparine only.

A total of 430 consecutive patients underwent 592 breast reconstructions. No statistically significant differences were found between the two groups in the incidence of flap failure (2.8 and 2.5%), microvascular thromboembolic complications (2.6 and 3.8%), venous congestion (3.4 and 2.8%), or overall complications (28.0 and 32.3%). Hematoma tended to occur more often in the group receiving acetylsalicylic acid (9.2 and 4.7%).

It was found that no protective effect of acetylsalicylic acid on microvascular complications was present. Given its known risks and the somewhat increased occurrence of hematoma in the present study, we stopped to routinely administer acetylsalicylic acid after autologous breast reconstruction.

Keywords

DIEP - TRAM - breast reconstruction - acetylsalicylic acid - thrombosis
 

  • References

  • 1 Jokuszies A, Herold C, Niederbichler AD, Vogt PM. Anticoagulative strategies in reconstructive surgery—clinical significance and applicability. Ger Med Sci 2012; 10: Doc01
    PubMedGoogle Scholar
  • 2 Adams Jr WP, Ansari MS, Hay MT , et al. Patency of different arterial and venous end-to-side microanastomosis techniques in a rat model. Plast Reconstr Surg 2000; 105 (1) 156-161
    CrossrefPubMedGoogle Scholar
  • 3 Acland R. Thrombus formation in microvascular surgery: an experimental study of the effects of surgical trauma. Surgery 1973; 73 (5) 766-771
    PubMedGoogle Scholar
  • 4 Hanasono MM, Butler CE. Prevention and treatment of thrombosis in microvascular surgery. J Reconstr Microsurg 2008; 24 (5) 305-314
    Article in Thieme ConnectPubMedGoogle Scholar
  • 5 Khouri RK, Cooley BC, Kunselman AR , et al. A prospective study of microvascular free-flap surgery and outcome. Plast Reconstr Surg 1998; 102 (3) 711-721
    Google Scholar
  • 6 Kroll SS, Schusterman MA, Reece GP , et al. Timing of pedicle thrombosis and flap loss after free-tissue transfer. Plast Reconstr Surg 1996; 98 (7) 1230-1233
    CrossrefPubMedGoogle Scholar
  • 7 Lecoq JP, Senard M, Hartstein GM, Lamy M, Heymans O. Thromboprophylaxis in microsurgery. Acta Chir Belg 2006; 106 (2) 158-164
    PubMedGoogle Scholar
  • 8 Ashjian P, Chen CM, Pusic A, Disa JJ, Cordeiro PG, Mehrara BJ. The effect of postoperative anticoagulation on microvascular thrombosis. Ann Plast Surg 2007; 59 (1) 36-39 , discussion 39–40
    CrossrefPubMedGoogle Scholar
  • 9 Peter FW, Franken RJ, Wang WZ , et al. Effect of low dose aspirin on thrombus formation at arterial and venous microanastomoses and on the tissue microcirculation. Plast Reconstr Surg 1997; 99 (4) 1112-1121
    CrossrefPubMedGoogle Scholar
  • 10 Buckley RC, Davidson SF, Das SK. The role of various antithrombotic agents in microvascular surgery. Br J Plast Surg 1994; 47 (1) 20-23
    CrossrefPubMedGoogle Scholar
  • 11 Khouri RK, Cooley BC, Kenna DM, Edstrom LE. Thrombosis of microvascular anastomoses in traumatized vessels: fibrin versus platelets. Plast Reconstr Surg 1990; 86 (1) 110-117
    CrossrefPubMedGoogle Scholar
  • 12 Chung TL, Pumplin DW, Holton III LH, Taylor JA, Rodriguez ED, Silverman RP. Prevention of microsurgical anastomotic thrombosis using aspirin, heparin, and the glycoprotein IIb/IIIa inhibitor tirofiban. Plast Reconstr Surg 2007; 120 (5) 1281-1288
    CrossrefPubMedGoogle Scholar
  • 13 Greenberg BM, Masem M, May Jr JW. Therapeutic value of intravenous heparin in microvascular surgery: an experimental vascular thrombosis study. Plast Reconstr Surg 1988; 82 (3) 463-472
    PubMedGoogle Scholar
  • 14 Rooks MD, Rodriguez Jr J, Blechner M, Zusmanis K, Hutton W. Comparative study of intraarterial and intravenous anticoagulants in microvascular anastomoses. Microsurgery 1994; 15 (2) 123-129
    CrossrefPubMedGoogle Scholar
  • 15 Zhang B, Wieslander JB. Improvement of patency in small veins following dextran and/or low-molecular-weight heparin treatment. Plast Reconstr Surg 1994; 94 (2) 352-358
    PubMedGoogle Scholar
  • 16 Rothkopf DM, Chu B, Bern S, May Jr JW. The effect of dextran on microvascular thrombosis in an experimental rabbit model. Plast Reconstr Surg 1993; 92 (3) 511-515
    PubMedGoogle Scholar
  • 17 Romano JE, Biel MA. Maintaining long-term vessel patency in microvascular surgery using tissue-type plasminogen activator. Otolaryngol Head Neck Surg 1991; 105 (3) 391-395
    PubMedGoogle Scholar
  • 18 Jayaprasad K, Mathew J, Thankappan K , et al. Safety and efficacy of low molecular weight dextran (dextran 40) in head and neck free flap reconstruction. J Reconstr Microsurg 2013; 29 (7) 443-448
    Article in Thieme ConnectPubMedGoogle Scholar
  • 19 Atiyeh BS, Hashim HA, Hamdan AM, Moucharafieh RS. Local recombinant tissue plasminogen activator (rt-PA) thrombolytic therapy in microvascular surgery. Microsurgery 1999; 19 (6) 265-271
    CrossrefPubMedGoogle Scholar
  • 20 Rohrich RJ, Handren J, Kersh R, Hergrueter CA, May Jr JW. Prevention of microvascular thrombosis with short-term infusion of human tissue-type plasminogen activator. Plast Reconstr Surg 1996; 98 (1) 118-128
    PubMedGoogle Scholar
  • 21 Brinkman JN, Derks LH, Klimek M, Mureau MAM. Perioperative fluid management and use of vasoactive and antithrombotic agents in free flap surgery: a literature review and clinical recommendations. J Reconstr Microsurg 2013; 29 (6) 357-366
    Article in Thieme ConnectPubMedGoogle Scholar
  • 22 Pugh CM, Dennis II RH, Massac EA. Evaluation of intraoperative anticoagulants in microvascular free-flap surgery. J Natl Med Assoc 1996; 88 (10) 655-657
    PubMedGoogle Scholar
  • 23 Disa JJ, Polvora VP, Pusic AL, Singh B, Cordeiro PG. Dextran-related complications in head and neck microsurgery: do the benefits outweigh the risks? A prospective randomized analysis. Plast Reconstr Surg 2003; 112 (6) 1534-1539
    CrossrefPubMedGoogle Scholar
  • 24 Brands MT, van den Bosch SC, Dieleman FJ, Bergé SJ, Merkx MA. Prevention of thrombosis after microvascular tissue transfer in the head and neck. A review of the literature and the state of affairs in Dutch Head and Neck Cancer Centers. Int J Oral Maxillofac Surg 2010; 39 (2) 101-106
    CrossrefPubMedGoogle Scholar
  • 25 Chien W, Varvares MA, Hadlock T, Cheney M, Deschler DG. Effects of aspirin and low-dose heparin in head and neck reconstruction using microvascular free flaps. Laryngoscope 2005; 115 (6) 973-976
    CrossrefPubMedGoogle Scholar
  • 26 Conrad MH, Adams Jr WP. Pharmacologic optimization of microsurgery in the new millennium. Plast Reconstr Surg 2001; 108 (7) 2088-2096 , quiz 2097
    CrossrefPubMedGoogle Scholar
  • 27 Stephan B, Schenk JF, Nemeh A, Pindur G. The use of antithrombotic agents in microvascular surgery. Clin Hemorheol Microcirc 2009; 43 (1–2) 51-56
    PubMedGoogle Scholar
  • 28 Savoie FH, Cooley BC, Gould JS. Evaluation of the effect of pharmacologic agents on crush-avulsion arterial injuries: a scanning electron microscopy study. Microsurgery 1991; 12 (4) 292-300
    CrossrefPubMedGoogle Scholar
  • 29 Ouriel K, Donayre C, Shortell CK , et al. The hemodynamics of thrombus formation in arteries. J Vasc Surg 1991; 14 (6) 757-762 , discussion 762–763
    CrossrefPubMedGoogle Scholar
  • 30 Esclamado RM, Carroll WR. The pathogenesis of vascular thrombosis and its impact in microvascular surgery. Head Neck 1999; 21 (4) 355-362
    CrossrefPubMedGoogle Scholar
  • 31 Li X, Cooley BC. Effect of anticoagulation and inhibition of platelet aggregation on arterial versus venous microvascular thrombosis. Ann Plast Surg 1995; 35 (2) 165-169 , discussion 169–170
    CrossrefPubMedGoogle Scholar
  • 32 Acosta R, Smit JM, Audolfsson T , et al. A clinical review of 9 years of free perforator flap breast reconstructions: an analysis of 675 flaps and the influence of new techniques on clinical practice. J Reconstr Microsurg 2011; 27 (2) 91-98
    Article in Thieme ConnectPubMedGoogle Scholar
  • 33 Patrono C, Coller B, Dalen JE , et al. Platelet-active drugs : the relationships among dose, effectiveness, and side effects. Chest 2001; 119 (1, Suppl) 39S-63S
    CrossrefPubMedGoogle Scholar