Incidence of heparin-induced thrombocytopenia in lower-extremity free flap reconstruction correlates with the overall surgical population.
Incidence of heparin-induced thrombocytopenia in lower-extremity free flap reconstruction correlates with the overall surgical population.
- 2018
Available online from MWHC library: 1995 - present
BACKGROUND: Lower-extremity free flap reconstruction is a growing trend in the management of lower extremity wounds. Heparin-induced thrombocytopenia (HIT) is a significant risk to free flap reconstruction. The purpose of this study was to investigate the incidence of HIT in patients receiving lower-extremity free flap surgery. CONCLUSIONS: These data suggest that the incidence of HIT in patients receiving lower-extremity free flaps correlates with the incidence of HIT nationally. The use of available scoring methods and other algorithms, combined with patient history helps to assess the immediate perioperative risks of HIT in the absence of rapid immunologic confirmatory tests. This knowledge can allow for successful free flap salvage or for performance of free flaps in patients with a history of HIT. Copyright (c) 2018. Published by Elsevier Ltd. METHODS: We conducted a retrospective, single center, IRB approved cohort study in which we reviewed all patients who received lower-extremity free flap surgeries between 2011 and 2016. The 4T and HIT Expert Probability (HEP) scores were calculated to assess the likelihood of HIT. RESULTS: One hundred patient charts revealed three patients with HIT. One patient was excluded due to a prior diagnosis of HIT. HIT incidence in patients receiving lower-extremity free flaps was between 1% and 3%, which is consistent with the national average. 4T scores indicated that two of three HIT-positive patients had a high probability of HIT (approximately 64%), and one of three HIT-positive patients had an intermediate probability (approximately 14%). HEP scoring indicated that all the three (100%) patients had HIT.
English
1748-6815
10.1016/j.bjps.2018.05.034 [doi] S1748-6815(18)30188-8 [pii]
*Free Tissue Flaps
*Heparin/ae [Adverse Effects]
*Leg Injuries/su [Surgery]
*Reconstructive Surgical Procedures/mt [Methods]
*Thrombocytopenia/ci [Chemically Induced]
Anticoagulants/ae [Adverse Effects]
Anticoagulants/tu [Therapeutic Use]
Female
Follow-Up Studies
Heparin/tu [Therapeutic Use]
Humans
Incidence
Lower Extremity
Male
Middle Aged
Postoperative Complications/pc [Prevention & Control]
Retrospective Studies
Thrombocytopenia/ep [Epidemiology]
Thrombosis/pc [Prevention & Control]
United States/ep [Epidemiology]
MedStar Washington Hospital Center
Surgery/Plastic Surgery
Journal Article
Available online from MWHC library: 1995 - present
BACKGROUND: Lower-extremity free flap reconstruction is a growing trend in the management of lower extremity wounds. Heparin-induced thrombocytopenia (HIT) is a significant risk to free flap reconstruction. The purpose of this study was to investigate the incidence of HIT in patients receiving lower-extremity free flap surgery. CONCLUSIONS: These data suggest that the incidence of HIT in patients receiving lower-extremity free flaps correlates with the incidence of HIT nationally. The use of available scoring methods and other algorithms, combined with patient history helps to assess the immediate perioperative risks of HIT in the absence of rapid immunologic confirmatory tests. This knowledge can allow for successful free flap salvage or for performance of free flaps in patients with a history of HIT. Copyright (c) 2018. Published by Elsevier Ltd. METHODS: We conducted a retrospective, single center, IRB approved cohort study in which we reviewed all patients who received lower-extremity free flap surgeries between 2011 and 2016. The 4T and HIT Expert Probability (HEP) scores were calculated to assess the likelihood of HIT. RESULTS: One hundred patient charts revealed three patients with HIT. One patient was excluded due to a prior diagnosis of HIT. HIT incidence in patients receiving lower-extremity free flaps was between 1% and 3%, which is consistent with the national average. 4T scores indicated that two of three HIT-positive patients had a high probability of HIT (approximately 64%), and one of three HIT-positive patients had an intermediate probability (approximately 14%). HEP scoring indicated that all the three (100%) patients had HIT.
English
1748-6815
10.1016/j.bjps.2018.05.034 [doi] S1748-6815(18)30188-8 [pii]
*Free Tissue Flaps
*Heparin/ae [Adverse Effects]
*Leg Injuries/su [Surgery]
*Reconstructive Surgical Procedures/mt [Methods]
*Thrombocytopenia/ci [Chemically Induced]
Anticoagulants/ae [Adverse Effects]
Anticoagulants/tu [Therapeutic Use]
Female
Follow-Up Studies
Heparin/tu [Therapeutic Use]
Humans
Incidence
Lower Extremity
Male
Middle Aged
Postoperative Complications/pc [Prevention & Control]
Retrospective Studies
Thrombocytopenia/ep [Epidemiology]
Thrombosis/pc [Prevention & Control]
United States/ep [Epidemiology]
MedStar Washington Hospital Center
Surgery/Plastic Surgery
Journal Article