BACKGROUND: Numerous protocols have been advocated for prevention of microvascular thrombosis after free tissue transfer. Many surgeons advocate the use of aspirin or other antiplatelet agents, but little objective evidence supports this practice. The purpose of this study is to evaluate the rate of microvascular thrombosis in patients undergoing free tissue transfer who are treated with or without anti-platelet agents. METHODS: All consecutive free flaps from 2002-2005 performed at a single tertiary cancer center were reviewed using a prospectively maintained database. Patients were divided into two groups based on postoperative anticoagulation administration. In Group 1, 325 mg of aspirin was administered daily for 5 days postoperatively. In Group 2, patients were treated with 5000 units of low-molecular-weight heparin (LMWH) per day until ambulating. LMWH was used primarily as a means of preventing deep venous thromboses. Patient demographics, procedure type, diagnosis, adjuvant treatment, and procedure type were recorded. Outcome variables included microvascular thrombosis, partial or total flap loss, hematoma, bleeding, deep venous thrombosis, pulmonary embolism, and death. RESULTS: Four hundred and seventy patients underwent 505 microvascular free flaps for reconstruction of oncologic defects. Two hundred and sixty flaps (group 1) received postoperative aspirin therapy, while 245 flaps (group 2) received low-molecular-weight heparin therapy. There was no statistically significant difference in the rate of either partial or total flap loss between the two groups. In addition, there was no statistically significant difference in interval hematoma formation or deep venous thrombosis formation between the two groups (power = 0.85). CONCLUSIONS: The type of postoperative anticoagulation used has no statistically significant effect on the incidence of free flap complications, including bleeding, thromboembolism, and flap loss. We conclude that neither aspirin nor low-molecular-weight heparin therapy demonstrates added benefit after microvascular free tissue transfer.
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