Impact of therapeutic and prophylactic anticoagulation after soft tissue tumor resection and microsurgical defect coverage in patients with high-risk coagulopathies or vascular diseases

Abstract

Abstract Introduction: The wide resection and microsurgical free flap coverage are main pillars of the multimodal treatment of soft tissue malignancies. In the challenging subpopulation of patients with preexisting hypercoagulabilities or documented vascular diseases, perioperative bridging anticoagulation is advised, which is considered by some surgeons as challenging. The authors investigate the outcomes and complication in this subpopulation shedding light on prophylactic and therapeutic anticoagulation. Material and Methods: A retrospective, monocentric evaluation of all patients with malignant soft tissue tumors undergoing tumor resection and defect reconstruction was performed from 2005 to 2021 in a comprehensive cancer care center for soft tissue tumors. The main inclusion criterium was preoperative anticoagulation therapy due to documented cardiovascular comorbidities or coagulopathies. Bridging was performed with an alternative anticoagulation regimen, either prophylactic or therapeutic. The demographics, bridging regimens, outcomes and complications are reported and compared between the two bridging groups. Results: Out of 240 soft tissue tumor patients receiving reconstructive microsurgical coverage 26 patients received 29 free flaps. Of these, 13 patients received prophylactic bridging (PB) while the other 13 received therapeutic bridging (TB). The flap survival rate was 85.7% in the PB and 66.7% in TB (p = 0.39). Overall postoperative complications were slightly greater in the therapeutic anticoagulation cohort, however, with no significant preference for a complication type. Conclusion Therapeutic bridging of high-risk patients with hypercoagulopathies or vascular diseases increases the overall surgical sites complications. When a clear systemic benefit of therapeutic anticoagulation is not present, a surgery related benefit is highly questionable.