Table 4 Our modified anticoagulation protocol for high-risk patients
Timing | Drugs | Bodyweight | Duration | |||
|---|---|---|---|---|---|---|
50–69 kg | 70–89 kg | > 90 kg | ||||
Preoperative | Inpatient stay (normal ward) | Antithrombin level assessment | ||||
Inpatient stay (normal ward) | Enoxaparin subcutaneous | 30 mg/day* (prophylactic dose) | 40 mg/day* (prophylactic dose) | 50 mg/day* (prophylactic dose) | ||
Intraoperative | Beginning of surgery | Tracheotomy (when needed) | ||||
After tracheotomy | Heparin intravenous | 600 U/hour | 800 U/hour | 1000 U/hour | During surgery | |
Just before flap dissection | Heparin intravenous | Bolus of 2000 U | Bolus of 3000 U | Bolus of 4000 U | ||
End of microsurgery | Heparin intravenous | Bolus of 1500 U | Bolus of 1500 U | Bolus of 2000 U | ||
Postoperative | Arrival at intensive care ward | Heparin intravenous | Continuous perfusion; goal: PTT 55–70 seconds | |||
Alternative: enoxaparin subcutaneous | 60 mg* | 80 mg* | 100 mg* | |||
Inpatient stay (normal ward) / postdischarge | Heparin intravenous | Continuous perfusion; goal: PTT 55–70 seconds | Until hospital discharge | |||
Alternative: Enoxaparin subcutaneous | 60 mg twice/day* (therapeutic dose) | 80 mg twice/day* (therapeutic dose) | 100 mg twice/day* (therapeutic dose) | Up to 4 weeks postsurgery | ||