Evidence-based medicine and prevention of thrombosis in microsurgery. Critical review

Prevention of thrombosis in microsurgery was the point of numerous publications without any referenced protocol. The question of this article was to know if it existed, for a patient who needed a microsurgical procedure, any medical treatment used, proved to lower the thrombotic risk. Using principles of evidence-based medicine, we observed that none of the medical treatments proved efficiency on preventing vascular thrombosis, arterial or venous. The low molecular weight heparins (LMWH) could be used on postoperatives to prevent the deep venous thrombosis of lower limbs but not to lower specially the microvascular thrombosis rate. Aspirin did not improve the positive rates and its adjunction to LMWH increased the bleeding. The evidence-based medicine, as we used it here, permits to conclude that the microsurgeon should not wait any miracle of the medical treatments. Until scientific studies prove efficacity of a treatment, the surgeon has to make a personal choice: keeping habits or following evidence-based medicine. The experience of the surgeon, of the anesthetist and of the paramedical team seem to be the main point to decrease the thrombotic risk during the multidisciplinary healing care of the patient. (C) 2010 Elsevier Masson SAS. All rights reserved.