Purpose: To evaluate coagulability in patients who have undergone microvascular breast reconstruction.

Materials and Methods: Data from twenty patients comprise this study. Coagulability was determined using prothrombin time (PT), partial thromboplastin time (PTT) and thromboelastography (TEG). Levels were drawn pre-operatively, immediately post-operatively (POD#0), POD#1 and POD#2. Patients who had undergone reconstruction without vascular complication were eligible. T-test was used for statistical comparison (p<0.05).

Results: PT evaluation demonstrated a significant prolongation when POD#0 (15.2±0.79), POD#1 (15.8±1.14) and POD#2 (15.2±0.84) were compared pre-operatively (13.7±0.53). PTT was prolonged when the results from POD#2 (34.5±6.4) were compared to pre-operative (29.2±3.86) and POD#0 (30.2±5.5). Evaluation of fibrin kinetics pre-operatively versus POD#0 demonstrated an increased time to specific clot strength (TEG K-time, 1.49±0.4 versus 1.91±0.7) and a slower build-up and cross-linking of fibrin (TEG alpha, 69.2±4.0 versus 65.1±7.7). Platelet surface activation (TEG MA) decreased on POD#0 (58.1±6.0) and POD#1 (57.1±6.5) when compared pre-operatively (63.0±6.0). Platelet activation increased by POD#2 (61.6±3.9) when compared to POD#0 (58.1±6.0) and POD#1 (57.1±6.5).

Conclusion: Coagulation measures by POD#1 demonstrated decreased coagulability with prolonged PT, decreased fibrin kinetics and decreased platelet activation. By POD#2 PT/PTT remained prolonged; however, platelet activation increased. By POD#2 platelet contribution to clot strength predominates over enzymatic pathways.