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.
Keywords
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Article info
Publication history
Published online: July 15, 2011
Accepted:
March 22,
2011
Identification
Copyright
© 2011 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.
