title: The value of postoperative anticoagulants to improve flap survival in the free radial forearm flap: a systematic review and retrospective multicentre analysis.
abstract: BACKGROUND
  Free radial forearm flap (FRFF) reconstruction is a valuable technique in head and neck surgery, which allows closure of large defects while striving to maintain functionality. Anticoagulative drugs are often administered to improve flap survival, although evidence regarding effectiveness is lacking.
  
  
  OBJECTIVE
  To investigate the effectiveness of postoperative anticoagulants to improve survival of the FRFF in head and neck reconstruction.
  
  
  METHODS
  Systematic review and multicentre, individual patient data meta-analysis.
  
  
  METHODS
  MEDLINE, EMBASE, Web of Science and CINAHL were searched for synonyms of 'anticoagulants' and 'free flap reconstruction'.
  
  
  METHODS
  Studies were critically appraised for directness of evidence and risk of bias. Authors of the highest quality publications were invited to submit their original data for meta-analysis.
  
  
  RESULTS
  Five studies were of adequate quality, and data from four studies (80%) were available for meta-analysis, describing 759 FRFF procedures. Anticoagulants used were as follows: aspirin (12%), low molecular weight dextran (18.3%), unfractioned heparin (28.1%), low molecular weight heparin (49%) and prostaglandin-E1 (2.1%). Thirty-one per cent did not receive anticoagulants. Flap failure occurred in 40 of 759 patients (5.3%) On univariate analysis, use of unfractioned heparin was associated with a higher rate of flap failure. However, these regimens were often administered to patients who had revision surgery of the anastomosis. In multivariate logistic regression analysis, anticoagulant use was not associated with improved flap survival or flap-related complications.
  
  
  CONCLUSIONS
  The studied anticoagulative drugs did not improve FRFF survival or lower the rate of flap-related complications. In addition, some anticoagulants may cause systemic complications.
authors.affiliation: Department of Otorhinolaryngology - Head and Neck Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: J E
authors.identifier: http://orcid.org/0000-0003-4288-0803
authors.initials: JE
authors.lastname: Swartz
authors.affiliation: Department of Otorhinolaryngology - Head and Neck Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.|Department of Otorhinolaryngology, Jeroen Bosch Hospital, Den Bosch, The Netherlands.
authors.forename: M C J
authors.initials: MC
authors.lastname: Aarts
authors.affiliation: Department of Otorhinolaryngology - Head and Neck Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.|Brain Center Rudolph Magnus, University Medical Center Utrecht, Utrecht, the Netherlands.
authors.forename: K M A
authors.initials: KM
authors.lastname: Swart
authors.affiliation: Plastic and Reconstructive Surgery Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
authors.forename: J J
authors.initials: JJ
authors.lastname: Disa
authors.affiliation: Department of Oral, Maxillofacial and Plastic Facial Surgery, Heinrich Braun Hospital, Zwickau, Germany.|Department of Oral, Maxillofacial and Plastic Facial Surgery, University Hospital of the Aachen University (RWTH), Aachen, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Gerressen
authors.affiliation: Department of Plastic and Reconstructive Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
authors.forename: Y-R
authors.initials: YR
authors.lastname: Kuo
authors.affiliation: Department of Otolaryngology-HNS, Oregon Health and Sciences University, Portland, OR, USA.
authors.forename: M K
authors.initials: MK
authors.lastname: Wax
authors.affiliation: Department of Otorhinolaryngology - Head and Neck Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.|Brain Center Rudolph Magnus, University Medical Center Utrecht, Utrecht, the Netherlands.
authors.forename: W
authors.initials: W
authors.lastname: Grolman
authors.affiliation: Department of Otorhinolaryngology - Head and Neck Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: W W
authors.initials: WW
authors.lastname: Braunius
mesh_terms: D000925:Anticoagulants / Q000627:therapeutic use*; D005542:Forearm / Q000601:surgery; D058752:Free Tissue Flaps; D006085:Graft Survival / Q000187:drug effects*; D006258:Head and Neck Neoplasms / Q000601:surgery; D006801:Humans; D015337:Multicenter Studies as Topic; D011182:Postoperative Care / Q000379:methods*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies
chemical_list: D000925:Anticoagulants
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