title: Anticoagulants and Statins As Pharmacological Agents in Free Flap Surgery: Current Rationale.
abstract: Microvascular free flaps are key components of reconstructive surgery, but despite their common use and usual reliability, flap failures still occur. Many pharmacological agents have been utilized to minimize risk of flap failure caused by thrombosis. However, the challenge of most antithrombotic therapy lies in providing patients with optimal antithrombotic prophylaxis without adverse bleeding effects. There is a limited but growing body of evidence suggesting that the vasoprotective and anti-inflammatory actions of statins can be beneficial for free flap survival. By inhibiting mevalonic acid, the downstream effects of statins include reduction of inflammation, reduced thrombogenicity, and improved vasodilation. This review provides a summary of the pathophysiology of thrombus formation and the current evidence of anticoagulation practices with aspirin, heparin, and dextran. In addition, the potential benefits of statins in the perioperative management of free flaps are highlighted.
authors.affiliation: Department of Plastic Surgery, Rhode Island Hospital, Brown University School of Medicine, Providence.
authors.forename: Adnan
authors.initials: A
authors.lastname: Pršić
authors.affiliation: Department of Plastic Surgery, Rhode Island Hospital, Brown University School of Medicine, Providence.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Kiwanuka
authors.affiliation: the Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass.
authors.forename: Stephanie A
authors.initials: SA
authors.lastname: Caterson
authors.affiliation: the Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass.
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Caterson
keywords: anticoagulants pharmacology; free flap; microsurgery; statins