Unfractionated Heparins, Low-Molecular-Weight Heparins, and Indirect Factor Xa Inhibitors in Plastic and Reconstructive Surgery: An Evidence-Based Review

Plast Reconstr Surg. 2024 Jun 1;153(6):1224e-1231e. doi: 10.1097/PRS.0000000000010695. Epub 2023 May 16.

Abstract

Venous thromboembolism can present with devastating complications and sequalae, particularly in the surgical patient. Current data support prophylactic anticoagulant use in high-risk hospitalized patients, defined as those with a Caprini Risk Assessment Model score of 7 or greater. The most frequently used chemoprophylaxis agents include unfractionated heparin, low-molecular-weight heparin, and indirect factor Xa inhibitors. The authors review the mechanisms of action, metabolism, reversal agents, indications, contraindications, advantages, and disadvantages of these medications in plastic and reconstructive surgery.

Publication types

  • Review

MeSH terms

  • Anticoagulants* / administration & dosage
  • Anticoagulants* / adverse effects
  • Anticoagulants* / therapeutic use
  • Evidence-Based Medicine
  • Factor Xa Inhibitors* / adverse effects
  • Factor Xa Inhibitors* / therapeutic use
  • Heparin* / administration & dosage
  • Heparin* / adverse effects
  • Heparin, Low-Molecular-Weight* / administration & dosage
  • Heparin, Low-Molecular-Weight* / adverse effects
  • Heparin, Low-Molecular-Weight* / therapeutic use
  • Humans
  • Plastic Surgery Procedures* / adverse effects
  • Plastic Surgery Procedures* / methods
  • Postoperative Complications / etiology
  • Postoperative Complications / prevention & control
  • Venous Thromboembolism* / etiology
  • Venous Thromboembolism* / prevention & control

Substances

  • Factor Xa Inhibitors
  • Heparin, Low-Molecular-Weight
  • Anticoagulants
  • Heparin