Postoperative Low-Dose Heparin Infusion Does Not Change Complication Rates Following Limb Revascularization.

Postoperative Low-Dose Heparin Infusion Does Not Change Complication Rates Following Limb Revascularization.

Ann Vasc Surg. 2018 Nov 26;:

Authors: Jayarajan SN, Holzem KM, Desai K, Sanchez LA, Zayed MA

Abstract
OBJECTIVE: Postoperative sub-therapeutic low-dose heparin infusion (LDHI) is sometimes administered in patients undergoing extremity arterial revascularization to maintain graft patency, and decrease risk of thrombosis. However, the safety of this management strategy is unknown.
METHODS: From 2013 to 2015, we retrospectively reviewed all patients undergoing upper and lower extremity arterial revascularization at a single university-affiliated medical center. Patients were grouped by receipt of LDHI within the first 24 hours postoperative period. Preoperative demographics, comorbidities, intraoperative measures, 30 day postoperative complications, arterial patency rates, and amputation rates were analyzed for each group.
RESULTS: We identified 379 patients who received extremity revascularization, and 56 (14.8%) of them had received LDHI. Patients who received LDHI were less likely to have an elective admission upon presentation (26.8% vs. 56%, p<0.001), or an admission from home (69.6% vs. 81.7%, p=0.04). They were more likely to have preoperative bleeding (44.6% vs. 22%, p<0.01), and need for emergent operation (23.2% vs. 11.8%, p=0.04). Postoperatively, although patients who received LDHI demonstrated a trend towards increased bleeding (48.2% vs. 33.7%, p=0.053), they did not demonstrate an increase in 30-day mortality (1.79% vs. 1.24%, p=0.55), or reoperation (19.7% vs. 12.4%, p=0.21). Multivariable analysis demonstrated that LDHI did not have a significant association with immediate postoperative bleeding (p=0.99), survival (p=0.13), primary patency (p=0.872), and amputation-free survival (p=0.387).
CONCLUSION: Although LDHI was more likely to be administered in patients who received emergent operations, risk adjusted analysis demonstrated that it was not associated with increased postoperative bleeding, mortality, short-term need for reintervention, or amputation following extremity arterial revascularization.

PMID: 30496900 [PubMed - as supplied by publisher]

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