Evidence map›Paper›PMID 39934564›Full record

SynthesisOral and maxillofacial surgery2025

Postoperative anticoagulation in patients with microvascular reconstruction - a systematic review.

Moritz Bleymehl, Julius Moratin, Maximilian Smielowski, Gregor Schnug, Thomas Rückschloß, Cornelius Busch, Michael Engel, Jürgen Hoffmann, Oliver Ristow

Abstract readSystematic Review
PubMed Publisher
In one paragraph

Synthesis in Oral and maxillofacial surgery, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Article
  2. [Research progress on perioperative anticoagulants in perioperative period of free flap transplantation].Zhongguo xiu fu chong jian wai ke za zhi = Zhongguo xiufu chongjian waike zazhi = Chinese journal of reparative and reconstructive surgery · 2025
    Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors.

Moritz BleymehlDepartment of Oral and Maxillofacial Surgery, University of Heidelberg, Im Neuenheimer Feld 400, D-69120, Heidelberg, Germany. Moritz.Bleymehl@med.uni-heidelberg.de.
Julius MoratinDepartment of Oral and Maxillofacial Surgery, University of Heidelberg, Im Neuenheimer Feld 400, D-69120, Heidelberg, Germany.
Maximilian SmielowskiDepartment of Oral and Maxillofacial Surgery, University of Heidelberg, Im Neuenheimer Feld 400, D-69120, Heidelberg, Germany.
Gregor SchnugDepartment of Oral and Maxillofacial Surgery, University of Heidelberg, Im Neuenheimer Feld 400, D-69120, Heidelberg, Germany.
Thomas RückschloßDepartment of Oral and Maxillofacial Surgery, University of Heidelberg, Im Neuenheimer Feld 400, D-69120, Heidelberg, Germany.
Cornelius BuschDepartment of Oral and Maxillofacial Surgery, University of Heidelberg, Im Neuenheimer Feld 400, D-69120, Heidelberg, Germany.
Michael EngelDepartment of Oral and Maxillofacial Surgery, University of Heidelberg, Im Neuenheimer Feld 400, D-69120, Heidelberg, Germany.
Jürgen HoffmannDepartment of Oral and Maxillofacial Surgery, University of Heidelberg, Im Neuenheimer Feld 400, D-69120, Heidelberg, Germany.
Oliver RistowDepartment of Oral and Maxillofacial Surgery, University of Heidelberg, Im Neuenheimer Feld 400, D-69120, Heidelberg, Germany.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveTo assess the currently applied regimens of antithrombotic therapy after microvascular reconstruction.

methodsA systematic literature review was performed using the MEDLINE/PubMed Database for work published until September 2022. Data synthesis and risk of bias were reported in accordance with NIH Study Quality Assessment Tools guidelines.

results204 articles were found including the keywords either in the abstract or in the title. After screening their abstracts and titles, 41 articles were identified as suitable and the full texts were retrieved. 23 studies were included in this review. No gold standard could be shown; on the contrary, the applied antithrombotic regimens varied widely. A broad consensus could be obtained that Dextran should no longer be used after an increased complication rate was proven. The most commonly used agents are unfractionated (UFH) as well as low molecular weight (LMWH) heparin and acetylsalecylic acid (ASA), although the literature results are partly contradictory.

conclusionsA consensus could be found that it is useful to perform thromboprophylaxis when the patient is immobilized, but there is no evidence for a survival advantage of the flap by chemical prophylaxis. On the contrary, it has been shown that there is an increased rate of bleeding complications and flap loss combined with the simultaneous use of multiple chemical anticoagulants. In conclusion the generalized use of anticoagulation is explained less by microvascular grafting than by general medical risk factors. Thus, large prospective RCTs will be needed to establish a gold standard therapeutic regimen.

Indexed as

AnticoagulantsMicrosurgeryPlastic Surgery ProceduresPostoperative CarePostoperative ComplicationsHeparin, Low-Molecular-WeightHumansMicrovesselsAnticoagulantsHeparin, Low-Molecular-WeightAnticoagulationFree flapMicrovascular surgeryReconstructive surgeryThromboprophylaxis

Identifiers

PMID39934564

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.