title: Tamoxifen-Related Thrombosis: An Experimental Study in Rat Venous Microvascular Anastomosis Model.
abstract: Tamoxifen is an estrogen receptor modulator and has been shown to increase risk for microvascular flap complications. This study aimed to investigate the clinical and histopathological effects of tamoxifen use in venous microvascular anastomosis model in rats. The role of vitamin E combination therapy and discontinuing tamoxifen therapy preoperatively were also evaluated.Forty rats were equally divided into 4 groups as follows: group 1 was given saline by oral gavage, group 2 was given tamoxifen citrate, group 3 was given tamoxifen citrate and vitamin E, and in group 4, tamoxifen citrate was given everyday except between days 12 and 16. In each group, femoral veins were dissected in each side and end-to-end anastomosis was performed in one side. Clinical and histopathological evaluations were performed. The ratio of total endothelial area to total vein area in a cross-sectional view of the vein was evaluated and compared.All veins with anastomosis in postoperative 15 minutes were found to be patent. In postoperative 1 week in groups 1 to 4, visible thrombus were present in 1, 3, 2, and 3 samples, respectively. Vitamin E group showed similar histopathological findings with control group. The ratio of endothelial layer to total vein cross-sectional area was increased in groups 2 and 4 in all samples. The increase was statistically significant between groups 2NA and 3NA (P = 0.023) and 2A and 1A (P = 0.006).Chronic tamoxifen consumption in the presence of anastomosis have led to prominent endothelial proliferation in rat femoral veins. Vitamin E combination therapy reversed this endothelial proliferation and should be focused in future studies.
authors.affiliation: From the *Department of Plastic Reconstructive and Aesthetic Surgery, Ataturk Training and Research Hospital, Bilkent, Ankara; †Department of Plastic Reconstructive and Aesthetic Surgery, Akhisar State Hospital, Akhisar; ‡Department of Plastic Reconstructive and Aesthetic Surgery, Turgutlu State Hospital, Turgutlu, Manisa; §Department of Pathology, Turgut Ozal University, Emek; and ∥Department of Biology, Gazi University, Ankara, Turkey.
authors.forename: Candemir
authors.initials: C
authors.lastname: Ceran
authors.forename: Ersin
authors.initials: E
authors.lastname: Aksam
authors.forename: Berrak
authors.initials: B
authors.lastname: Aksam
authors.forename: Sibel
authors.initials: S
authors.lastname: Yenidünya
authors.forename: Zekiye
authors.initials: Z
authors.lastname: Suludere
authors.forename: Mustafa Erol
authors.initials: ME
authors.lastname: Demirseren
mesh_terms: D000714:Anastomosis, Surgical; D000818:Animals; D000975:Antioxidants / Q000627:therapeutic use; D004965:Estrogen Antagonists / Q000008:administration & dosage / Q000009:adverse effects*; D005260:Female; D005268:Femoral Vein / Q000473:pathology / Q000601:surgery*; D008866:Microsurgery; D011183:Postoperative Complications / Q000139:chemically induced* / Q000517:prevention & control; D051381:Rats; D017208:Rats, Wistar; D013629:Tamoxifen / Q000008:administration & dosage / Q000009:adverse effects*; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000139:chemically induced* / Q000517:prevention & control; D014810:Vitamin E / Q000627:therapeutic use
chemical_list: D000975:Antioxidants; D004965:Estrogen Antagonists; D013629:Tamoxifen; D014810:Vitamin E