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Poster Networking

Diagnostics, OMICs and Advanced Technologies

PB0072 - Enhancing Anticoagulation Monitoring and Therapy in Patients Undergoing Microvascular Reconstruction in Maxillofacial Surgery: First results from the interims analysis of the prospective study

Sunday, June 23, 2024
13:45 – 14:45 ICT
Room: Exhibition Hall

    Presenting Author(s)

  • LH

    Lars Heubner

    Anesthesiology Resident / post-doc Research Fellow
    Department of Anaesthesiology and Intensive Care Medicine, University Hospital Carl Gustav Carus Dresden
    Dresden, Sachsen, Germany

    • Co-Author(s)

  • PS

    Peter Spieth

    Deputy Head of Department
    Dept. of Anaesthesiology and Intensive Care Medicine, University Hospital Carl Gustav Carus, Dresden, Germany
    Dresden, Sachsen, Germany

  • KH

    Kiriaki Katerina Heubner

    Resident for Oral and Maxillofacial Surgery
    Department of Oral and Maxillofacial Surgery, University Hospital Carl Gustav Carus Dresden
    Dresden, Sachsen, Germany

  • CB

    Christian Bräuer

    Senior consultant
    Department of Oral and Maxillofacial Surgery, Facial Plastic Surgery, University of Rostock
    Rostock, Mecklenburg-Vorpommern, Germany

  • OV

    Oliver Vicent

    Senior Consultant
    Dept. of Anaesthesiology and Intensive Care Medicine, University Hospital Carl Gustav Carus, Dresden
    Dresden, Sachsen, Germany

  • AG

    Andreas Güldner

    Senior consultant
    Dept. of Anaesthesiology and Intensive Care Medicine, University Hospital Carl Gustav Carus, Dresden
    Dresden, Sachsen, Germany

  • MM

    Martin Mirus

    Senior consultant
    Dept. of Anaesthesiology and Intensive Care Medicine, University Hospital Carl Gustav Carus, Dresden
    Dresden, Sachsen, Germany

  • JS

    Jürgen Schmidt

    Senior consultant
    Dept. of Anaesthesiology and Intensive Care Medicine, University Hospital Carl Gustav Carus, Dresden
    Dresden, Sachsen, Germany

  • OT

    Oliver Tiebel

    Deputy Head of Department
    Institute of Clinical Chemistry, University Hospital Carl Gustav Carus Dresden
    Dresden, Sachsen, Germany

  • PG

    Philipp Groene

    Senior consultant
    Department of Anaesthesiology, University Hospital, LMU Munich
    München, Sachsen, Germany

  • JB

    Jan Beyer-Westendorf, Prof, MD

    Head of Division "Thrombosis & Hemostasis", Head of "Thrombosis Research Unit"
    Department of Medicine I Thrombosis Research, University Hospital Carl Gustav Carus Dresden
    Dresden, Sachsen, Germany

  • GL

    Günter Lauer

    Head of Department
    Department of Oral and Maxillofacial Surgery, University Hospital Carl Gustav Carus Dresden
    Dresden, Sachsen, Germany

  • HL

    Henry Leonhardt

    Deputy Head of Department
    Department of Oral and Maxillofacial Surgery, University Hospital Carl Gustav Carus Dresden
    Dresden, Sachsen, Germany

  • TS

    Tom Alexander Schröder

    Resident for Oral and Maxillofacial Surgery / Clinical Scientist
    Department of Oral and Maxillofacial Surgery, University Hospital Carl Gustav Carus Dresden
    Dresden, Sachsen, Germany

Background: In reconstructive surgery, a serious complication is loss of a microvascular free flap due to perfusion disorders, especially thrombosis.

Aims: The aim of this ongoing prospective management study (planned sample size 200 pts.) is to analyze the predictive value of POC devices for flap perfusion disorders .

Methods: All Patients undergoing reconstructive surgery using microvascular free flaps provide blood samples for viscoelastic testing (VET) and standard laboratory testing (SLT). The primary outcome is defined as free flap loss until 30 days after hospital discharge (short-term follow-up). The study is performed according to the published study protocol (Schröder TA et al. J Pers Med. 2022 Jul 27;12(8):1229).

Results: So far, 100 consecutive patients were enrolled between February 2022 and March 2023. Free-flap perfusion deficiency occurred in 8 patients (8%), and in 10 patients (10%) a venous congested flap was observed (2 patients presented both). In 8 patients with perfusion deficiency re-operation was performed in 5 (63%), whereby 4 flaps could be saved. In 10 patients with venous congestion, skin pricking was performed in 7 patients (70%), whereby 5 flaps could be saved. Overall free-flap loss from any etiology occurred in 6 patients (6%). Clot firmness for extrinsic VET (EX-test) at 5 (A5) and 10 (A10) minutes as well as maximum clot firmness (MCF) were significantly higher in patients with free-flap loss, indicating hypercoagulability, while none of the SLT could predict free-flap loss. Although antithrombin-levels were higher at baseline in patients with free-flap loss, this did not seem to be protective.

Conclusion(s): In our interim-analysis, overall free-flap loss was as high as expected with 6%. Only VET (performed within several minutes after induction of anesthesia) was able to predict overall free-flap loss. We conclude that whole blood testing with VET is more appropriate to detect hypercoagulability and to predict free-flap loss than SLT.