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Safety of a regimen for thromboprophylaxis in head and neck cancer microvascular reconstructive surgery: non-concurrent cohort study

  • Author Footnotes
    d Formerly Specialist Registrar, University Hospital Aintree.
    T.K. Blackburn
    Footnotes
    d Formerly Specialist Registrar, University Hospital Aintree.
    Affiliations
    University Department of Oral Maxillo-Facial & Facial Plastic Surgery, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, United Kingdom
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  • Author Footnotes
    e Formerly Senior House Officer, University Hospital Aintree.
    K.R. Java
    Correspondence
    Corresponding author. Tel.: +44 151 529 5283; fax: +44 192 529 5288.
    Footnotes
    e Formerly Senior House Officer, University Hospital Aintree.
    Affiliations
    Foundation Year 1, Warrington General Hospital, Lovely Lane, Warrington WA5 1QG, United Kingdomf
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  • D. Lowe
    Affiliations
    Mersey Regional Maxillofacial Unit and Head and Neck Cancer Centre, University Hospital Aintree, Liverpool, England L9 7AL, United Kingdom
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  • J.S. Brown
    Affiliations
    Mersey Regional Maxillofacial Unit and Head and Neck Cancer Centre, University Hospital Aintree, Liverpool, England L9 7AL, United Kingdom
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  • S.N. Rogers
    Affiliations
    Mersey Regional Maxillofacial Unit and Head and Neck Cancer Centre, University Hospital Aintree, Liverpool, England L9 7AL, United Kingdom
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  • Author Footnotes
    d Formerly Specialist Registrar, University Hospital Aintree.
    e Formerly Senior House Officer, University Hospital Aintree.
    f http://www.headandneckcancer.co.uk/.

      Abstract

      We aimed to assess bleeding complications after increasing the thromboprophylactic dose of dalteparin from 2500 to 5000 units 12 h preoperatively in line with guidance on risk stratification and appropriate pharmacological thromboprophylaxis. We evaluated two groups of patients for confounding factors and bleeding, a prospective consecutive high dose group (n = 29), and a retrospective low dose group (n = 30) who had had ablative and microvascular reconstructive surgery for oral or oropharyngeal cancer. The bleeding index over 5 days (range 40–60) was used as an objective measure of perioperative bleeding. The null hypothesis was that there was no difference in the bleeding index between the two groups. We found no significant difference in the mean bleeding index between the two groups (p = 0.56) (mean (SD) bleeding index in the high dose group 45.3 (26.1), and 48.7 (18.1) in the low dose group). The 95% confidence interval (CI) was −1.51 lower to 0.83 higher in the high dose group. Five patients (2 (7%) in the high dose, and 3 (10%) in the low dose group) were returned to theatre with bleeding complications. There was a trend to a higher failure rate of free flaps in the high dose group (4 (13%) complete, and 1 partial failure compared with 1 (3%) complete and 1 partial failure in the low dose group). There were no symptomatic thromboembolic events in either group. An increased dose of dalteparin did not seem to increase conventional surgical bleeding complications, which was consistent with the null hypothesis at evidence level 2b, but a larger sample is needed to explore its impact on venous thromboembolic events and on the failure of microvascular free flaps.

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