Research progress on perioperative anticoagulants in perioperative period of free flap transplantation_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

QIN Haokun ¹ ,  DENG Chengliang ^1,2

1. Department of Burn and Plastic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi Guizhou, 563003, P. R. China;
2. Collaborative Innovation Center of Tissue Repair and Regeneration Medicine, Zunyi Guizhou, 563003, P. R. China;

Corresponding?author：

DENG Chengliang, Email: cheliadeng@sina.com

Keywords：

Free flap; anticoagulants; perioperative period; thrombosis; complications

DOI：

10.7507/1002-1892.202507042

Video：

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Objective To review current status of clinical application and research progress of different anticoagulants in perioperative period of free flap transplantation. Methods A comprehensive review of recent relevant literature was conducted, focusing on clinical research concerning the application of anticoagulants in the perioperative period of free flap transplantation. The administration route, timing, dosage selection, effectiveness, and safety of commonly used and novel anticoagulants were summarized. Results At present, the anticoagulants mainly used in the perioperative period of free flap transplantation include drugs for venous thrombosis prophylaxis, drugs for arterial thrombosis prophylaxis, and physical/colloidal anticoagulants, etc. The administration strategies can be classified into two major categories: single-agent anticoagulation and combined anticoagulation. Single-agent anticoagulation mainly includes unfractionated heparin, low-molecular-weight heparin, aspirin, and novel anticoagulants. Combined anticoagulation is commonly a synergistic anticoagulation regimen dominated by heparin drugs, combined with aspirin, different antiplatelet drugs, and expansion agents. Studies indicate that perioperative anticoagulant administration can effectively reduce the risk of thrombosis in free flaps and improve the overall flap survival rate. However, significant differences exist in the impact of drug types, administration routes, initiation timing, and dosage intensity on efficacy and bleeding risk. A unified, standardized application protocol has not yet been established. In addition, there has been a growing number of studies on novel anticoagulant drugs. However, their superiority and optimal application strategies in the field of free flap transplantation still necessitate more high-quality evidence. Conclusion Perioperative anticoagulation therapy represents one of the key strategies for improving the survival rate of free flaps. However, there is still a lack of high-level evidence to establish a standard protocol. Future research should focus on the optimization of individualized anticoagulation strategies, the validation of the effectiveness of new anticoagulants, and the exploration of the advantages of different anticoagulation strategies. At the same time, attention should be paid to balancing anticoagulation and bleeding risks to promote the standardization of clinical practice and the improvement of treatment safety.

Citation： QIN Haokun, DENG Chengliang. Research progress on perioperative anticoagulants in perioperative period of free flap transplantation. Chinese Journal of Reparative and Reconstructive Surgery, 2025, 39(11): 1474-1484. doi: 10.7507/1002-1892.202507042 Copy

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2.
3. Leclère FM, Schoofs M, Buys B, et al. 1.9 μm diode laser assisted vascular microanastomoses: Experience in 40 clinical procedures. Lasers Surg Med, 2011, 43(4): 293-297.
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5.
6.
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8.
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13.
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19. Parks AL, Stevens SM, Woller SC. Anticoagulant therapy in renal insufficiency theme: Anticoagulation in complex situations. Thromb Res, 2024, 241:109097. doi: 10.1016/j.thromres.2024.109097.
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30. Duet ML, Tapp M, Peoples A, et al. Acetylsalicylic acid dosage and duration effects on deep inferior epigastric perforator (DIEP) flap breast reconstruction. Plast Reconstr Surg Glob Open, 2023, 11(4 Suppl): 103-104.
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39. Kasthurirengan S, Murugan MS, Murugan PS, et al. Distal flap heparinisation versus systemic bolus of low molecular weight heparin for the prevention of vascular congestion in microvascular free flaps: a randomised clinical trial. J Maxillofac Oral Surg, 2023. doi: 10.1007/s12663-023-01999-0.
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Chinese Journal of Reparative and Reconstructive Surgery

Research progress on perioperative anticoagulants in perioperative period of free flap transplantation

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