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Enhancing Anticoagulation Monitoring and Therapy in Patients Undergoing Microvascular Reconstruction in Maxillofacial Surgery: A Prospective Observational Trial

Background: In reconstructive surgery, loss of a microvascular free flap due to perfusion disorders, especially thrombosis, is a serious complication. In recent years, viscoelastic testing (VET) has become increasingly important in point-of-care (POC) anticoagulation monitoring. This paper describes...

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Autores principales: Schröder, Tom A., Leonhardt, Henry, Haim, Dominik, Bräuer, Christian, Papadopoulos, Kiriaki K., Vicent, Oliver, Güldner, Andreas, Mirus, Martin, Schmidt, Jürgen, Held, Hanns C., Tiebel, Oliver, Birkner, Thomas, Beyer-Westendorf, Jan, Lauer, Günter, Spieth, Peter M., Koch, Thea, Heubner, Lars
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9410460/
https://www.ncbi.nlm.nih.gov/pubmed/36013177
http://dx.doi.org/10.3390/jpm12081229
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author Schröder, Tom A.
Leonhardt, Henry
Haim, Dominik
Bräuer, Christian
Papadopoulos, Kiriaki K.
Vicent, Oliver
Güldner, Andreas
Mirus, Martin
Schmidt, Jürgen
Held, Hanns C.
Tiebel, Oliver
Birkner, Thomas
Beyer-Westendorf, Jan
Lauer, Günter
Spieth, Peter M.
Koch, Thea
Heubner, Lars
author_facet Schröder, Tom A.
Leonhardt, Henry
Haim, Dominik
Bräuer, Christian
Papadopoulos, Kiriaki K.
Vicent, Oliver
Güldner, Andreas
Mirus, Martin
Schmidt, Jürgen
Held, Hanns C.
Tiebel, Oliver
Birkner, Thomas
Beyer-Westendorf, Jan
Lauer, Günter
Spieth, Peter M.
Koch, Thea
Heubner, Lars
author_sort Schröder, Tom A.
collection PubMed
description Background: In reconstructive surgery, loss of a microvascular free flap due to perfusion disorders, especially thrombosis, is a serious complication. In recent years, viscoelastic testing (VET) has become increasingly important in point-of-care (POC) anticoagulation monitoring. This paper describes a protocol for enhanced anticoagulation monitoring during maxillofacial flap surgery. Objective: The aim of the study will be to evaluate, in a controlled setting, the predictive value of POC devices for the type of flap perfusion disorders due to thrombosis or bleeding. VET, Platelet monitoring (PM) and standard laboratory tests (SLT) are comparatively examined. Methods/Design: This study is an investigator-initiated prospective trial in 100 patients undergoing maxillofacial surgery. Patients who undergo reconstructive surgery using microvascular-free flaps will be consecutively enrolled in the study. All patients provide blood samples for VET, PM and SLT at defined time points. The primary outcome is defined as free flap loss during the hospital stay. Statistical analyses will be performed using t-tests, including the Bonferroni adjustment for multiple comparisons. Discussion: This study will help clarify whether VET can improve individualized patient care in reconstruction surgery. A better understanding of coagulation in relation to flap perfusion disorders may allow real-time adaption of antithrombotic strategies and potentially prevent flap complications.
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spelling pubmed-94104602022-08-26 Enhancing Anticoagulation Monitoring and Therapy in Patients Undergoing Microvascular Reconstruction in Maxillofacial Surgery: A Prospective Observational Trial Schröder, Tom A. Leonhardt, Henry Haim, Dominik Bräuer, Christian Papadopoulos, Kiriaki K. Vicent, Oliver Güldner, Andreas Mirus, Martin Schmidt, Jürgen Held, Hanns C. Tiebel, Oliver Birkner, Thomas Beyer-Westendorf, Jan Lauer, Günter Spieth, Peter M. Koch, Thea Heubner, Lars J Pers Med Study Protocol Background: In reconstructive surgery, loss of a microvascular free flap due to perfusion disorders, especially thrombosis, is a serious complication. In recent years, viscoelastic testing (VET) has become increasingly important in point-of-care (POC) anticoagulation monitoring. This paper describes a protocol for enhanced anticoagulation monitoring during maxillofacial flap surgery. Objective: The aim of the study will be to evaluate, in a controlled setting, the predictive value of POC devices for the type of flap perfusion disorders due to thrombosis or bleeding. VET, Platelet monitoring (PM) and standard laboratory tests (SLT) are comparatively examined. Methods/Design: This study is an investigator-initiated prospective trial in 100 patients undergoing maxillofacial surgery. Patients who undergo reconstructive surgery using microvascular-free flaps will be consecutively enrolled in the study. All patients provide blood samples for VET, PM and SLT at defined time points. The primary outcome is defined as free flap loss during the hospital stay. Statistical analyses will be performed using t-tests, including the Bonferroni adjustment for multiple comparisons. Discussion: This study will help clarify whether VET can improve individualized patient care in reconstruction surgery. A better understanding of coagulation in relation to flap perfusion disorders may allow real-time adaption of antithrombotic strategies and potentially prevent flap complications. MDPI 2022-07-27 /pmc/articles/PMC9410460/ /pubmed/36013177 http://dx.doi.org/10.3390/jpm12081229 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Study Protocol
Schröder, Tom A.
Leonhardt, Henry
Haim, Dominik
Bräuer, Christian
Papadopoulos, Kiriaki K.
Vicent, Oliver
Güldner, Andreas
Mirus, Martin
Schmidt, Jürgen
Held, Hanns C.
Tiebel, Oliver
Birkner, Thomas
Beyer-Westendorf, Jan
Lauer, Günter
Spieth, Peter M.
Koch, Thea
Heubner, Lars
Enhancing Anticoagulation Monitoring and Therapy in Patients Undergoing Microvascular Reconstruction in Maxillofacial Surgery: A Prospective Observational Trial
title Enhancing Anticoagulation Monitoring and Therapy in Patients Undergoing Microvascular Reconstruction in Maxillofacial Surgery: A Prospective Observational Trial
title_full Enhancing Anticoagulation Monitoring and Therapy in Patients Undergoing Microvascular Reconstruction in Maxillofacial Surgery: A Prospective Observational Trial
title_fullStr Enhancing Anticoagulation Monitoring and Therapy in Patients Undergoing Microvascular Reconstruction in Maxillofacial Surgery: A Prospective Observational Trial
title_full_unstemmed Enhancing Anticoagulation Monitoring and Therapy in Patients Undergoing Microvascular Reconstruction in Maxillofacial Surgery: A Prospective Observational Trial
title_short Enhancing Anticoagulation Monitoring and Therapy in Patients Undergoing Microvascular Reconstruction in Maxillofacial Surgery: A Prospective Observational Trial
title_sort enhancing anticoagulation monitoring and therapy in patients undergoing microvascular reconstruction in maxillofacial surgery: a prospective observational trial
topic Study Protocol
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9410460/
https://www.ncbi.nlm.nih.gov/pubmed/36013177
http://dx.doi.org/10.3390/jpm12081229
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