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J Reconstr Microsurg 2022; 38(01): 084-088
DOI: 10.1055/s-0041-1732431
Original Article

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

Nicholas C. Bene
1   Division of Plastic Surgery, Lahey Hospital & Medical Center, Burlington, Massachusetts
,
Raquel A. Minasian
2   Division of Plastic Surgery, University of Southern California, Los Angeles, California
,
Saiqa I. Khan
1   Division of Plastic Surgery, Lahey Hospital & Medical Center, Burlington, Massachusetts
,
Haley E. Desjardins
3   Division of Plastic Surgery, University of Colorado, Aurora, Colorado
,
Lifei Guo
1   Division of Plastic Surgery, Lahey Hospital & Medical Center, Burlington, Massachusetts
› Author Affiliations Funding None.
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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.

Keywords

ethnicity - breast - microsurgery - coagulation

Note

This study was presented at the New England Society of Plastic and Reconstructive Surgeons (NESPRS) 2019 in Newport, RI.




Publication History

Received: 08 December 2020

Accepted: 12 May 2021

Article published online:
17 August 2021

© 2021. Thieme. All rights reserved.

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  • References

  • 1 Williams SF, Nicholas SB, Vaziri ND, Norris KC. African Americans, hypertension and the renin angiotensin system. World J Cardiol 2014; 6 (09) 878-889
    CrossrefPubMedGoogle Scholar
  • 2 Exner DV, Dries DL, Domanski MJ, Cohn JN. Lesser response to angiotensin-converting-enzyme inhibitor therapy in black as compared with white patients with left ventricular dysfunction. N Engl J Med 2001; 344 (18) 1351-1357
    CrossrefPubMedGoogle Scholar
  • 3 Gadegbeku CA, Lea JP, Jamerson KA. Update on disparities in the pathophysiology and management of hypertension: focus on African Americans. Med Clin North Am 2005; 89 (05) 921-933 , 930
    CrossrefPubMedGoogle Scholar
  • 4 Weir MR, Gray JM, Paster R, Saunders E. The Trandolapril Multicenter Study Group. Differing mechanisms of action of angiotensin-converting enzyme inhibition in black and white hypertensive patients. Hypertension 1995; 26 (01) 124-130
    CrossrefPubMedGoogle Scholar
  • 5 Cohn JN, Archibald DG, Ziesche S. et al. Effect of vasodilator therapy on mortality in chronic congestive heart failure. Results of a Veterans Administration Cooperative Study. N Engl J Med 1986; 314 (24) 1547-1552
    CrossrefPubMedGoogle Scholar
  • 6 Cohn JN, Johnson G, Ziesche S. et al. A comparison of enalapril with hydralazine-isosorbide dinitrate in the treatment of chronic congestive heart failure. N Engl J Med 1991; 325 (05) 303-310
    CrossrefPubMedGoogle Scholar
  • 7 Carson P, Ziesche S, Johnson G, Cohn JN. Vasodilator-Heart Failure Trial Study Group. Racial differences in response to therapy for heart failure: analysis of the vasodilator-heart failure trials. J Card Fail 1999; 5 (03) 178-187
    CrossrefPubMedGoogle Scholar
  • 8 Iwade M, Iwade K, Nomura M, Ozaki M. Differences in perioperative coagulation between Japanese and other ethnic groups undergoing laparoscopic cholecystectomy. Surg Endosc 2003; 17 (12) 2012-2015
    CrossrefPubMedGoogle Scholar
  • 9 Klatsky AL, Armstrong MA, Poggi J. Risk of pulmonary embolism and/or deep venous thrombosis in Asian-Americans. Am J Cardiol 2000; 85 (11) 1334-1337
    CrossrefPubMedGoogle Scholar
  • 10 Liu HS, Kho BC, Chan JC. et al. Venous thromboembolism in the Chinese population--experience in a regional hospital in Hong Kong. Hong Kong Med J 2002; 8 (06) 400-405
    PubMedGoogle Scholar
  • 11 Cheuk BL, Cheung GC, Cheng SW. Epidemiology of venous thromboembolism in a Chinese population. Br J Surg 2004; 91 (04) 424-428
    CrossrefPubMedGoogle Scholar
  • 12 Chau KY, Yuen ST, Wong MP. Clinicopathological pattern of pulmonary thromboembolism in Chinese autopsy patients: comparison with Caucasian series. Pathology 1997; 29 (03) 263-266
    CrossrefPubMedGoogle Scholar
  • 13 Chan CW, Hoaglund FT. Pulmonary thromboembolism and venous thrombosis in the Chinese. Clin Orthop Relat Res 1980; (150) 253-260
    PubMedGoogle Scholar
  • 14 Singhal D, Smorodinsky E, Guo L. Differences in coagulation among Asians and Caucasians and the implication for reconstructive microsurgery. J Reconstr Microsurg 2011; 27 (01) 57-62
    Article in Thieme ConnectPubMedGoogle Scholar
  • 15 Char S, Rudnicki P, Mackey W, Guo L. A systematic review of ethnic disparity in vascular thrombosis between East Asians and Westerners. J Vasc Surg 2020; in press
    PubMedGoogle Scholar
  • 16 Kwok AC, Agarwal JP. An analysis of free flap failure using the ACS NSQIP database. Does flap site and flap type matter?. Microsurgery 2017; 37 (06) 531-538
    CrossrefPubMedGoogle Scholar
  • 17 Mirzabeigi MN, Wang T, Kovach SJ, Taylor JA, Serletti JM, Wu LC. Free flap take-back following postoperative microvascular compromise: predicting salvage versus failure. Plast Reconstr Surg 2012; 130 (03) 579-589
    CrossrefPubMedGoogle Scholar
  • 18 Gijsberts CM, den Ruijter HM, Asselbergs FW, Chan MY, de Kleijn DP, Hoefer IE. Biomarkers of coronary artery disease differ between Asians and Caucasians in the general population. Glob Heart 2015; 10 (04) 301-311.e11
    CrossrefPubMedGoogle Scholar
  • 19 Healy C, Allen Sr RJ. The evolution of perforator flap breast reconstruction: twenty years after the first DIEP flap. J Reconstr Microsurg 2014; 30 (02) 121-125
    PubMedGoogle Scholar
  • 20 Patel NG, Ramakrishnan V. Microsurgical tissue transfer in breast reconstruction. Clin Plast Surg 2017; 44 (02) 345-359
    CrossrefPubMedGoogle Scholar
  • 21 Mamtani A, Morrow M. Why are there so many mastectomies in the United States?. Annu Rev Med 2017; 68: 229-241
    CrossrefPubMedGoogle Scholar
  • 22 National Cancer Institute. Breast Cancer Risk in American Women. September 24, 2012. Accessed April 2, 2019 at: https://www.cancer.gov/types/breast/risk-fact-sheet
    PubMedGoogle Scholar
  • 23 Chang EI, Chang EI, Soto-Miranda MA. et al. Evolution of bilateral free flap breast reconstruction over 10 years: optimizing outcomes and comparison to unilateral reconstruction. Plast Reconstr Surg 2015; 135 (06) 946e-953e
    CrossrefPubMedGoogle Scholar
  • 24 Fischer JP, Sieber B, Nelson JA. et al. Comprehensive outcome and cost analysis of free tissue transfer for breast reconstruction: an experience with 1303 flaps. Plast Reconstr Surg 2013; 131 (02) 195-203
    CrossrefPubMedGoogle Scholar
  • 25 Offodile II AC, Chatterjee A, Vallejo S, Fisher CS, Tchou JC, Guo L. A cost-utility analysis of the use of preoperative computed tomographic angiography in abdomen-based perforator flap breast reconstruction. Plast Reconstr Surg 2015; 135 (04) 662e-669e
    CrossrefPubMedGoogle Scholar
  • 26 Taylor GI, Palmer JH. The vascular territories (angiosomes) of the body: experimental study and clinical applications. Br J Plast Surg 1987; 40 (02) 113-141
    CrossrefPubMedGoogle Scholar
  • 27 Park JE, Chang DW. Advances and innovations in microsurgery. Plast Reconstr Surg 2016; 138 (05) 915e-924e
    CrossrefPubMedGoogle Scholar
  • 28 Granzow JW, Levine JL, Chiu ES, Allen RJ. Breast reconstruction with the deep inferior epigastric perforator flap: history and an update on current technique. J Plast Reconstr Aesthet Surg 2006; 59 (06) 571-579
    CrossrefPubMedGoogle Scholar
  • 29 Allen RJ, Treece P. Deep inferior epigastric perforator flap for breast reconstruction. Ann Plast Surg 1994; 32 (01) 32-38
    CrossrefPubMedGoogle Scholar
  • 30 Soltanian H, Garcia RM, Hollenbeck ST. Current concepts in lower extremity reconstruction. Plast Reconstr Surg 2015; 136 (06) 815e-829e
    CrossrefPubMedGoogle Scholar
  • 31 Guerra AB, Metzinger SE, Bidros RS. et al. Bilateral breast reconstruction with the deep inferior epigastric perforator (DIEP) flap: an experience with 280 flaps. Ann Plast Surg 2004; 52 (03) 246-252
    CrossrefPubMedGoogle Scholar
  • 32 Cheung YF, Chay GW, Ma ESK. Ethnic differences in coagulation factor abnormalities after the Fontan procedure. Pediatr Cardiol 2006; 27 (01) 96-101
    CrossrefPubMedGoogle Scholar
  • 33 Lutsey PL, Cushman M, Steffen LM. et al. Plasma hemostatic factors and endothelial markers in four racial/ethnic groups: the MESA study. J Thromb Haemost 2006; 4 (12) 2629-2635
    CrossrefPubMedGoogle Scholar
  • 34 White RH. The epidemiology of venous thromboembolism. Circulation 2003; 107 (23, Suppl 1): I4-I8
    CrossrefPubMedGoogle Scholar
  • 35 Masoomi H, Clark EG, Paydar KZ. et al. Predictive risk factors of free flap thrombosis in breast reconstruction surgery. Microsurgery 2014; 34 (08) 589-594
    CrossrefPubMedGoogle Scholar
  • 36 Fu R, Chang MM, Chen M, Rohde CH. A qualitative study of breast reconstruction decision-making among Asian immigrant women living in the United States. Plast Reconstr Surg 2017; 139 (02) 360e-368e
    CrossrefPubMedGoogle Scholar
  • 37 Offodile II AC, Tsai TC, Wenger JB, Guo L. Racial disparities in the type of postmastectomy reconstruction chosen. J Surg Res 2015; 195 (01) 368-376
    CrossrefPubMedGoogle Scholar
  • 38 Siotos C, Naska A, Bello RJ. et al. Survival and disease recurrence rates among breast cancer patients following mastectomy with or without breast reconstruction. Plast Reconstr Surg 2019; 144 (02) 169e-177e
    CrossrefPubMedGoogle Scholar
  • 39 Chung A, Huynh K, Lawrence C, Sim MS, Giuliano A. Comparison of patient characteristics and outcomes of contralateral prophylactic mastectomy and unilateral total mastectomy in breast cancer patients. Ann Surg Oncol 2012; 19 (08) 2600-2606
    CrossrefPubMedGoogle Scholar