Safety of a regimen for thromboprophylaxis in head and neck cancer microvascular reconstructive surgery: non-concurrent cohort study.
| Title: | Safety of a regimen for thromboprophylaxis in head and neck cancer microvascular reconstructive surgery: non-concurrent cohort study. |
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| Authors: | Blackburn TK; University Department of Oral Maxillo-Facial & Facial Plastic Surgery, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, United Kingdom.; Java KR; Lowe D; Brown JS; Rogers SN |
| Source: | The British journal of oral & maxillofacial surgery [Br J Oral Maxillofac Surg] 2012 Apr; Vol. 50 (3), pp. 227-32. Date of Electronic Publication: 2011 Jul 14. |
| Publication Type: | Comparative Study; Journal Article |
| Language: | English |
| Journal Info: | Publisher: Churchill Livingstone Country of Publication: Scotland NLM ID: 8405235 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1532-1940 (Electronic) Linking ISSN: 02664356 NLM ISO Abbreviation: Br J Oral Maxillofac Surg Subsets: MEDLINE |
| Imprint Name(s): | Original Publication: Edinburgh, U.K. : Churchill Livingstone, c1984- |
| MeSH Terms: | Anticoagulants/*therapeutic use ; Dalteparin/*therapeutic use ; Head and Neck Neoplasms/*surgery ; Plastic Surgery Procedures/*methods ; Venous Thrombosis/*prevention & control; Anticoagulants/administration & dosage ; Dalteparin/administration & dosage ; Free Tissue Flaps/blood supply ; Microsurgery/methods ; Mouth Neoplasms/surgery ; Oropharyngeal Neoplasms/surgery ; Platelet Aggregation Inhibitors/therapeutic use ; Postoperative Hemorrhage/etiology ; Venous Thromboembolism/prevention & control ; Adult ; Aged ; Aged, 80 and over ; Blood Loss, Surgical ; Cohort Studies ; Female ; Follow-Up Studies ; Graft Survival ; Humans ; Male ; Middle Aged ; Prospective Studies ; Retrospective Studies ; Safety ; Treatment Outcome |
| Abstract: | We aimed to assess bleeding complications after increasing the thromboprophylactic dose of dalteparin from 2500 to 5000 units 12h preoperatively in line with guidance on risk stratification and appropriate pharmacological thromboprophylaxis. We evaluated two groups of patients for confounding factors and bleeding, a prospective consecutive high dose group (n=29), and a retrospective low dose group (n=30) who had had ablative and microvascular reconstructive surgery for oral or oropharyngeal cancer. The bleeding index over 5 days (range 40-60) was used as an objective measure of perioperative bleeding. The null hypothesis was that there was no difference in the bleeding index between the two groups. We found no significant difference in the mean bleeding index between the two groups (p=0.56) (mean (SD) bleeding index in the high dose group 45.3 (26.1), and 48.7 (18.1) in the low dose group). The 95% confidence interval (CI) was -1.51 lower to 0.83 higher in the high dose group. Five patients (2 (7%) in the high dose, and 3 (10%) in the low dose group) were returned to theatre with bleeding complications. There was a trend to a higher failure rate of free flaps in the high dose group (4 (13%) complete, and 1 partial failure compared with 1 (3%) complete and 1 partial failure in the low dose group). There were no symptomatic thromboembolic events in either group. An increased dose of dalteparin did not seem to increase conventional surgical bleeding complications, which was consistent with the null hypothesis at evidence level 2b, but a larger sample is needed to explore its impact on venous thromboembolic events and on the failure of microvascular free flaps.; (Copyright © 2011 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.) |
| Substance Nomenclature: | 0 (Anticoagulants); 0 (Platelet Aggregation Inhibitors); S79O08V79F (Dalteparin) |
| Entry Date(s): | Date Created: 20110715 Date Completed: 20120925 Latest Revision: 20221207 |
| Update Code: | 20260130 |
| DOI: | 10.1016/j.bjoms.2011.03.265 |
| PMID: | 21752500 |
| Database: | MEDLINE |
Comparative Study; Journal Article