Background
There is no international consensus on the use of perioperative thromboprophylaxis in digital
replantation. Suboptimal perioperative management may lead to replant failure which
compromises extremity function, worsens psychosocial outcomes for patients and incurs
significant cost. This systematic review evaluates and compares the efficacy and safety of
perioperative antithrombotic protocols used in digital replantation.
Methods
A PRISMA-compliant prospectively registered (PROSPERO CRD42018108695) systematic
review was conducted. Cochrane Central Register of Controlled Trials, Medline, EMBASE
and Scopus were searched up until December 2019. Articles were assessed for eligibility in
duplicate by two independent reviewers. All comparative studies which examined the use of
perioperative thromboprophylaxis in digital replantation were eligible for inclusion.
Results
Collectively, 1,025 studies were identified of which 7 met full inclusion criteria reporting
data from 635 patients (908 digital replants, 86% male, average age 37.3 years). Laceration
was the most commonly reported mechanism of injury (68%) with 33% of replantation
occurring in Tamai zone III. Fourteen distinct perioperative protocols were identified. One
study reported significantly higher digital survival with continuous heparin infusion versus
bolus heparin. Five studies demonstrated a significantly higher incidence of complications
amongst patients treated with systemic heparin.
Conclusions
The clinical efficacy and safety of peri-operative antithrombotic therapy following digital
replantation remains equivocal. The perceived benefits of improved digital survival must be
tempered against the adverse systemic side effects of antithrombotic and anticoagulant
therapies until further prospectively collected data sets become available.