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Incidence of heparin-induced thrombocytopenia in lower-extremity free flap reconstruction correlates with the overall surgical population.

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Citation: Journal of Plastic, Reconstructive & Aesthetic Surgery: JPRAS. 71(9):1252-1259, 2018 09.PMID: 29980457Institution: MedStar Washington Hospital CenterDepartment: Surgery/Plastic SurgeryForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *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]Year: 2018 Local holdings: Available online from MWHC library: 1995 - presentISSN:

1748-6815

Name of journal: Journal of plastic, reconstructive & aesthetic surgery : JPRASAbstract: 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.All authors: Attinger C, Elmarsafi T, Evans KK, Stimac G, Walters ETFiscal year: FY2019Fiscal year of original publication: FY2018Digital Object Identifier:

https://dx.doi.org/10.1016/j.bjps.2018.05.034

Date added to catalog: 2018-07-30

Holdings ( 1 )
Title notes ( 7 )

Holdings
Item type	Current library	Collection	Call number	Status	Date due	Barcode
Journal Article	MedStar Authors Catalog	Article	29980457	Available		29980457

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.

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.

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