# Continuous administration of heparin during free flap surgery for head and neck tumors reduces the risk of pulmonary embolism

## TL;DR

Administering heparin during surgery for head and neck tumor reconstruction lowers the risk of lung blood clots.

## Contribution

Intraoperative heparin use significantly reduces pulmonary embolism risk compared to postoperative administration.

## Key findings

- Intraoperative heparinization reduced PE incidence to 6.5% versus 17.4% in postoperative group.
- No significant difference in bleeding complications between the two groups.
- Effect was more pronounced in patients receiving forearm flaps.

## Abstract

This study investigated the impact of different anticoagulation protocols on the incidence of pulmonary embolism (PE) in patients with head and neck tumors who underwent microvascular flap reconstruction.

We conducted a retrospective case‒control analysis of 92 patients. Two anticoagulation strategies were evaluated: one group received 10000 IU of unfractionated heparin (UFH) administered over 24 hours (h) starting 6 h postoperatively for one week.The other group received 3 IU of UFH per kilogram of total body weight per h at the onset of surgery until 6 h after surgery. The activated partial thromboplastin time (aPTT) target was subsequently set at 50 to 60 seconds for one week.

The group that received intraoperative UFH presented a significantly lower incidence of PE (6.5% compared with 17.4% in the group that received 10,000 IU of UFH 6 h postoperatively), independent of the type of flap used for reconstruction. This effect was particularly notable in patients who received a forearm flap for reconstruction. There was no statistically significant difference in the incidence of bleeding requiring intervention between the two groups; however, a trend was noted, as postoperative bleeding occurred more frequently in the group receiving intraoperative heparinization.

Our findings suggest that the intraoperative administration of UFH is effective in significantly reducing the risk of PE in patients with head and neck tumors undergoing free flap reconstruction. These results highlight the need for further research to optimize anticoagulation protocols that effectively balance thromboembolic prevention and the risk of bleeding complications.