Schmitz M, Riss R, Kneser U, Jokuszies A, Harder Y, Beier J P, Schäfer D J, Vogt P M, Fansa H, Andree C, Pierer G, Horch R E
Universitätsklinikum Erlangen, Plastisch- und Handchirurgische Klinik, Erlangen.
Handchir Mikrochir Plast Chir. 2011 Dec;43(6):376-83. doi: 10.1055/s-0031-1291317. Epub 2011 Nov 17.
Microsurgery is a very relevant component of reconstructive surgery. In this context anticoagulation plays an increasing role. At the moment there are no unanimously accepted prospective studies or generally accepted regimes available that could serve as evidence-based guidelines for the prevention of thrombosis in microsurgery. With regard to this problem the aim of a series of workshops during the annual meetings of the German-speaking group for microsurgery in 2009 and 2010 was to establish a first possible consensus. This article reflects the main aspects of the ongoing development of a generally acceptable guideline for anticoagulation in microsurgery as interim report of these consensus workshops. Basically there are 3 main agents in thromboprophylaxis available: antiplatelet drugs, dextran and heparin. In the course of the workshops no general use of aspirin or dextran for anticoagulation in microsurgery was recommended. The use of heparin as anticoagulation agent is advisable for different indications. Low molecular heparins (LMH) have certain advantages in comparison to unfractionated heparins (UFH) and are therefore preferred by most participants. Indications for UFH are still complex microsurgical revisions, renal failure and some specific constellations in patients undergoing reconstruction of the lower extremity, where the continuous administration of heparin is recommended. At the moment of clamp release a single-shot of UFH is still given by many microsurgeons, despite a lack of scientific evidence. Future prospective clinical trials and the establishment of a generally accepted evidence-based guideline regarding anticoagulation treatment in microsurgery are deemed necessary.
显微外科是重建外科中一个非常重要的组成部分。在这种情况下，抗凝作用日益重要。目前尚无一致认可的前瞻性研究或普遍接受的方案可作为显微外科预防血栓形成的循证指南。针对这一问题，2009年和2010年德语区显微外科学组年会期间一系列研讨会的目的是达成初步的可能共识。本文反映了作为这些共识研讨会中期报告的显微外科抗凝通用指南正在制定过程中的主要方面。基本上，血栓预防有三种主要药物：抗血小板药物、右旋糖酐和肝素。在研讨会过程中，不建议在显微外科手术中普遍使用阿司匹林或右旋糖酐进行抗凝。肝素作为抗凝剂在不同适应症下是可取的。与普通肝素（UFH）相比，低分子肝素（LMH）有一定优势，因此大多数参与者更倾向于使用。UFH的适应症仍然是复杂的显微外科翻修手术、肾衰竭以及下肢重建患者的一些特定情况，在这些情况下建议持续使用肝素。尽管缺乏科学证据，但目前许多显微外科医生在松开血管夹时仍会单次使用UFH。未来有必要进行前瞻性临床试验并建立关于显微外科抗凝治疗的普遍接受的循证指南。
