title: Anticoagulation for Hypercoagulable Patients Associated with Complications after Large Cranioplasty Reconstruction.
abstract: BACKGROUND
  Despite advancements in materials and techniques used for cranial reconstruction, complication rates following reconstructive cranioplasty remain significant.
  
  
  METHODS
  In this study, the authors assessed the association of perioperative anticoagulation use and/or a hypercoagulable state with minor (i.e., not requiring surgical intervention) and major (i.e., surgical intervention required) complications after reconstructive cranioplasty for large skull defects. A retrospective cohort review of 108 consecutive cranioplasties performed between 2011 and 2014 was conducted. A multiple logistic regression analysis was performed to identify the adjusted association between the predictor variables and complications.
  
  
  RESULTS
  Twenty-three primary (21.3 percent) and 85 secondary (78.7 percent) cranioplasties were performed on 94 patients with a median age of 50 years (interquartile range, 38 to 63 years). Median full-thickness calvarial defect size was 154 cm (interquartile range, 104 to 230 cm). Eleven minor (10.2 percent) and 18 major postoperative complications (16.7 percent) occurred in 26 cases (24.1 percent). Multiple logistic regression analysis revealed that coagulation status (i.e., perioperative use of anticoagulation therapy or hypercoagulable state) was statistically significant in predicting minor complications (OR, 7.8; 95 percent CI, 2.4 to 25.2; p = 0.001). Of note, the odds of a minor complication were an order of magnitude higher when both perioperative anticoagulation and a hypercoagulable state were present.
  
  
  CONCLUSIONS
  To the authors' knowledge, this is the first study to document that the use of perioperative anticoagulant therapy for patients with thromboembolic conditions is a positive predictor of complications following cranioplasty reconstruction.
  
  
  METHODS
  Therapeutic, III.
authors.affiliation: Baltimore, Md.; and Rockford, Ill. From the Departments of Plastic and Reconstructive Surgery, Neurosurgery, and Hematology, The Johns Hopkins University School of Medicine; and the University of Illinois College of Medicine.
authors.forename: Eric W
authors.initials: EW
authors.lastname: Sankey
authors.forename: Joseph
authors.initials: J
authors.lastname: Lopez
authors.forename: Shuting Susan
authors.initials: SS
authors.lastname: Zhong
authors.forename: Harlyn
authors.initials: H
authors.lastname: Susarla
authors.forename: Ignacio
authors.initials: I
authors.lastname: Jusué-Torres
authors.forename: Jason
authors.initials: J
authors.lastname: Liauw
authors.forename: Judy
authors.initials: J
authors.lastname: Huang
authors.forename: Michael
authors.initials: M
authors.lastname: Streiff
authors.forename: Henry
authors.initials: H
authors.lastname: Brem
authors.forename: Chad R
authors.initials: CR
authors.lastname: Gordon
mesh_terms: D000328:Adult; D000925:Anticoagulants / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000379:methods*; D011183:Postoperative Complications / Q000139:chemically induced*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012886:Skull / Q000601:surgery*; D019851:Thrombophilia / Q000188:drug therapy*
chemical_list: D000925:Anticoagulants
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