The clinical effectiveness and safety of intravenous unfractionated heparin following digital replantation and revascularization: A narrative systematic review

BACKGROUND: Digital replants and revascularization (DRV) have been performed since the 1960s but there are no recognized standard peri-operative anticoagulation practices. A narrative systematic review of the clinical effectiveness and safety of therapeutic peri-operative unfractionated heparin following DRV was undertaken. METHODS: A review of the literature from 1985 to March 2022 was conducted using Medline, Embase, CINAHL and EBM reviews. Unfractionated heparin (UFH) use following DRV was compared to low-molecular weight heparin, other anticoagulants or no anticoagulation. Randomized trials, observational studies as well as guidelines were selected and independently screened. The Revised Cochrane risk-of-bias (RoB 2) tool and ROBINS-I were used to appraise risk of bias. RESULTS: While the search strategy identified 1490 references, only six studies met the inclusion criteria. Significant heterogeneity and the low methodological quality of the evidence precluded a meta-analysis. Among the four studies that documented the surgical success rate associated with the use of a therapeutic dose of UFH post DRV, only two reported improved clinical outcomes. Evidence of a higher complication rate related to UFH use was found in four studies. Low quality evidence suggests that a therapeutic dose of unfractionated heparin leads to a higher risk of complications when compared with heparin given as an intermittent bolus of unfractionated heparin or subcutaneous heparin, or prostaglandin E1 or no heparin. CONCLUSIONS: Current evidence suggests that IV UFH use following DRV has no significant impact on the success of the intervention. Heparin use may not be innocuous as some studies showed increased bleeding complications.

Abstract aus PubMed (NCBI) für den zitierten Eintrag, in der Originalsprache wiedergegeben. Maßgeblich ist die Fassung der Originalpublikation.

Das Abstract wird nicht übersetzt, damit die eigene Wortwahl der Autoren erhalten bleibt.

This systematic review of six studies found no significant impact of therapeutic intravenous unfractionated heparin on digital replantation success, while low-quality evidence suggests more complications than with intermittent bolus or subcutaneous heparin, prostaglandin E1, or no heparin.

Erfahren Sie, wie diese Forschung mit der klinischen Praxis verknüpft ist

Weitere begutachtete Studien in der Kategorie „Sicherheit & Infektionskontrolle“.

• Leech-Assisted Flap Salvage — Systematic Review of 277 Cases — Whitaker et al. (2012)
• Auswirkungen der Hirudotherapie auf Leberfunktionen, Lipidprofil und Insulinsensitivität bei Ratten mit metabolischem Syndrom — Bilden A et al. (2026)
• Efficacy and Safety of Hirudotherapy for Improving Sperm Quality Parameters in Male Infertility: A Randomized Controlled Trial — Abtahi-Forooshani M et al. (2026)
• Improvement of patient care through hirudotherapy and the management of leeches from their reception to their disposal in France — Vaesken C et al. (2023)
• Hirudotherapy in Medicine and Dentistry — Jha K et al. (2015)
• Management of Chronic Non-healing Wounds by Hirudotherapy — Iqbal A et al. (2017)
• Hirudotherapie lindert arthritische Schmerzen bei Patienten mit verschiedenen chronischen Schmerzsyndromen: eine retrospektive Analyse — Loeser J et al. (2020)
• Hirudotherapy (medicinal leeches) for treatment of upper airway obstruction in a dog — Trenholme H, Masseau I, Reinero C (2021)
• Analyse antibiotikaresistenter Infektionen im Zusammenhang mit Hirudotherapie — Brauer P et al. (2024)
• Leech Me Alone! Atraumatic Hemarthrosis after Hirudotherapy — Curcio J, Lloyd C (2020)

Alle von der ASH analysierten Studien →